title: Surgical management of monocular elevation deficiency combined with inferior rectus restriction.
abstract: OBJECTIVE
  To evaluate the results of ipsilateral inferior rectus (IR) recession, when performed alone or in combination with contralateral superior rectus (SR) recession in patients with monocular elevation deficiency (MED) and IR tightness.
  
  
  METHODS
  The medical records of patients with MED and tight IR muscle were retrospectively reviewed. Patients underwent either ipsilateral IR recession alone (IR group) or combined with contralateral SR recession (IR+SR group). Pre- and postoperative ocular motility and alignment and fundus torsion were analyzed. Abnormal head posture was recorded. All patients were followed for at least 6 months.
  
  
  RESULTS
  A total of 23 patients were identified. Mean patient age at time of surgery was 9.8 ± 8.7 years (range, 3-45 years). Ten patients underwnet ipsilateral IR recession 5-8 mm; 13 patients, 4 mm ipsilateral IR recession combined with 5-12 mm contralateral SR recession. Both groups experienced marked improvement in ocular alignment in the primary position (P = 0.34). However, there was a statistically better ocular alignment in both upgaze (P = 0.03) and downgaze (P < 0.01) in the IR+SR group, with a lower degree of fundus intorsion (P < 0.01). An ipsilateral head tilt developed in 70% of patients in the IR group and in 54% of patients in the IR+SR group.
  
  
  CONCLUSIONS
  In this patient cohort, combined contralateral SR recession with ipsilateral IR recession reduced postoperative IR underaction and achieved better ocular alignment in upgaze and downgaze.
authors.affiliation: Cairo University Faculty of Medicine, Cairo, Egypt. Electronic address: ahmedawadein@yahoo.com.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Awadein
authors.affiliation: Cairo University Faculty of Medicine, Cairo, Egypt.
authors.forename: Dina
authors.initials: D
authors.lastname: El-Fayoumi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005133:Eye Movements / Q000502:physiology; D005260:Female; D006257:Head; D006801:Humans; D008297:Male; D008875:Middle Aged; D015835:Ocular Motility Disorders / Q000503:physiopathology / Q000601:surgery*; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D011187:Posture; D012189:Retrospective Studies; D013536:Suture Techniques; D015348:Vision, Binocular / Q000502:physiology