An Easy and Safe Operation Technique for Monocular Elevation Deficiency
Birsen Gokyigit, MD; Selcen Celik, MD; Asli Inal, MD; Ebru D. Aygit, MD; Osman B. Ocak, MD
University of Health Science, Istanbul Beyoglu Education and Research Eye Hospital
Introduction: Monocular elevation deficiency (MED) occurs either congenitally or acquired following some devastating situation. If the inferior rectus function is normal, horizontal recti superior transpositions were performed with or without augmentation suture. We aimed to introduce new alternative operation for these patients.
Methods: There were 4 patients who were operated and followed at least 3 months in this study. Only one patient had congenital MED. Patients’ records are evaluated retrospectively.
Surgical technique: Conjunctiva was opened with limbal incision between 4 and 8 o’clock; medial, lateral and superior rectus muscles were exposed. 6/0 non-absorbable suture was used for grasping 1/6 width of muscle portion, 10 mm posterior to the insertions of medial and lateral rectus muscles. Then, sutures were tied and locked three times, approximately 8-10 mm behind the insertion of superior rectus. Scleral suture was not used. Superior rectus plication performed either during or after the surgery according to remaining deviation.
Results: Two of the patients had brain surgery, one had stroke in their history. When patients’ preoperative vertical deviations in primary position were between 20-35 prism diopter (pd), they were found between 0-4 pd. without any inferior gaze restriction.
Discussion: In these cases, we preferred to perform muscle union surgery prior to superior rectus placation or inferior rectus recession or both. In this procedure, while performing transposition and union of medial and lateral rectus muscles, we did not use any scleral suture.
Conclusion: We noticed that this technique is easier, safer than and as effective as other transposition procedures.
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3. Park KA, Oh SY. Muscle union procedure with medial rectus recession for unilateral abducens palsy.J Pediatr Ophthalmol Strabismus. 2013 Mar 13;50