Recurrent unilateral restrictive elevation deficit in childhood: a tailored approach
Deepesh Unni1, Abdul Shameer2, Pradeep Sharma2
1Ophthalmology, All India Institute of Medical Sciences Dr RP Centre for Ophthalmic Sciences, New Delhi, Delhi, India unnideepesh@yahoo.com.
Insights
Monocular elevation deficiency in a child presented a surgical challenge due to recurrent hypotropia. Successful management required a tailored, multi-stage approach with long-term follow-up.
Area of Science:
- Ophthalmology
- Pediatric Strabismus Surgery
Background:
- Monocular elevation deficiency (MED) presents diverse clinical challenges in strabismus surgery.
- Management often necessitates individualized treatment strategies.
Observation:
- A 6-month-old child with MED showed primary inferior rectus muscle involvement, causing restricted elevation.
- Initial disinsertion of the muscle relieved hypotropia but led to recurrence.
Findings:
- The patient experienced multiple recurrences, requiring additional procedures like antimitotic application and superior rectus plication.
- A tailored, multi-stage surgical approach was ultimately successful, with a 3-year follow-up.
Implications:
- This case highlights the potentially intractable nature of restrictive strabismus involving a single muscle.
- Recalcitrant cases demand persistent, tailored surgical interventions and close monitoring for optimal outcomes.
Abstract:
Monocular elevation deficiency poses a challenge to strabismus surgeons on account of its varied clinical presentations as well as management which often needs a tailored approach. We report on a young child who presented to us at 6 months of age with a clinical course marked by primary involvement of the inferior rectus muscle in one eye causing restricted elevation in all gazes and complete relief of hypotropia following disinsertion of the affected muscle but followed by recurrence and additional procedures (antimitotic application and superior rectus plication) for the same. She followed a recalcitrant clinical course which was marked by multiple recurrences requiring a tailored approach and finally managed successfully with a follow-up of 3 years, by now. This case demonstrates the almost intractable nature of restrictive pathology involving a single muscle warranting multiple surgeries and a close follow-up with good surgical outcome.
More Related Videos
05:28Author Spotlight: Enhancing Upper Limb Rehabilitation in Stroke Patients Through Advanced Robotic and Neuromodulation Technologies
Published on: October 11, 2024
07:20Author Spotlight: Repetitive Transcranial Magnetic Stimulation Combined with Movement Observation in Cerebral Palsy
Published on: August 9, 2024