double elevator palsy: a 10-year review of operated patients

purpose: to evaluate the clinical manifestations and surgical results in patients with double elevator palsy operated at labbafinejad eye center from 1993 to 2004. methods: the study was conduct on hospital records of 20 patients with double elevator palsy. patients were classified in three groups including primary elevator muscle palsy (9 subjects), primary supranuclear palsy with secondary inferior rectus restriction (4 subjects) and pure inferior rectus restriction (7 subjects) according to results of forced duction test (fdt), force generation test (fgt) and bell’s reflex. patients in the first group underwent knapp procedure, the second group underwent knapp procedure and inferior rectus muscle recession simultaneously and the third group underwent vertical recess-resect or mere inferior rectus recess operation. success was defined as deviation < 5 pd for correction of deviation and > 25% improvement in muscle restriction after all strabismus operations. results: the patients included 10 male and 10 female subjects with mean age of 12.6 yr (1.5-32 yr). mean follow up period was 22± 20 months. mean pre- and post-operative deviations were 32±8 pd and 3.8 ± 8 pd (p<0.0001) and mean muscle restrictions before and after operation were -3.5± 0.7 and -2.3±1.2 (p<0.0001), respectively. overall success rate was 77% for correction of deviation and 80% for improvement in muscle restriction. conclusion: appropriate surgery must be individualized in patients with double elevator palsy. fdt, and fgt and bell’s reflex evaluation are useful to determine the underlying pathology and determine the optimal surgical procedure in each case.