A Novel Technique Using Paretic Superior Rectus as a Globe Suspender for Monocular Elevation Deficiency

Area of Science:

• Ophthalmology
• Pediatric Surgery
• Strabismus Surgery

Background:

• Monocular elevation deficiency is a rare condition causing limited eye elevation.
• Acquired cases can result from various factors, including post-abscess complications.
• Previous surgical options carry risks, necessitating alternative approaches.

Purpose of the Study:

• To present a novel surgical procedure for acquired monocular elevation deficiency.
• To utilize the paretic superior rectus muscle as a globe suspender.
• To resolve hypotropia and improve ocular alignment and cosmesis.

Main Methods:

• A modified superior rectus muscle splitting and vertical transposition technique was performed.
• The paretic superior rectus muscle was split into medial and temporal halves and reattached anteriorly.
• This aimed to reduce risks associated with the traditional Knapp procedure.

Main Results:

• Postoperative hypotropia improved from 40 to 9 prism diopters in primary gaze.
• Cosmetic outcomes were satisfactory, with improved eye alignment.
• Minimal residual elevation restriction persisted, with no change in visual acuity.

Conclusions:

• Superior rectus muscle splitting and vertical transposition is a potentially safer and simpler alternative to the Knapp procedure.
• This technique may offer a reduced risk of anterior segment ischemia.
• Further research is needed to validate these findings in a larger cohort.