Comparative Study of Outcomes by Surgical Procedures and Monocular Elevation Deficiency Syndrome in Indian Population

Introduction: Monocular elevation deficiency syndrome (MEDS) is a monocular elevation deficiency in abduction and adduction characterised by the hypofunction of superior rectus (SR) and inferior oblique muscles. Only a limited number of studies are published on the management of this problem. Herein, the indications and types of surgery for monocular elevation deficiency syndrome are reported.Methods: In this retrospective cohort study, all MEDS patients reported during 2010 to 2020 were retrieved from Electronic Medical Records after approval from the Hospital Ethical Committees. The data were exported in a pre-tested online format. The demographic and clinical information and data of surgeries, including strabismus and ptosis, were reported. The follow-up data were collected in a specific format. Strabismus was managed using Knapp procedure, Inferior Rectus recession and a combination of both approaches. Ptosis was corrected by Levator Palpebral Superioris (LPS) resection and brow suspension. The data were analysed using SPSS 22 based on descriptive analysis and cross-tabulation.Results: The cohort consists of 62 cases (females 26, males 36) of patients with mean age 17.00±12.31 years 40/62 cases comprised the paediatric age group. Knapp was carried out in 39, IR recession was carried out in 35, and combined Knapp+IR recession was performed in 17 cases based on FDT and FGT data. The comparative study found significant difference amongst these techniques (P=0.04). Ptosis correction was carried out by LPS resection in 21 and brow suspension in 23 cases depending on LPS function. This comparative study did not find any significant difference in the results (P=0.234).Conclusion: MEDS is a rare disease with various clinical features. The surgical management of strabismus may have more success for the combined technique than for those applied alone.