Surgical Outcomes in Double Elevator Palsy

Jaspreet Sukhija

Purpose: To study the outcome of Knapp's procedure or Inferior rectus recession in the management of double elevator palsy.

Methods: Fifteen patients with double elevator palsy with no horizontal deviation were divided into 3 groups of five patients each. In all cases forced duction test was negative. Group 1 included patients with hypotropia of ≥ 25 Δ. Group II comprised of patients with hypotropia less than 25Δ which was subdivided into group A and B. Group A had five patients where partial Knapps was done and group B included five patients where inferior rectus recession of 5-6 mm was performed.

Results: Mean age of patients was 8.53 years. Best corrected visual acuity ranged from 20/120 to 20/30. In group I orthotropia was achieved in three cases, residual deficit of 10 Δ was observed in one patient and a marked overcorrection occurred in one case. In group II where a partial knapps was performed, all patients had orthotropia. In group B residual hypotropia of 8 Δ was present in two eyes. These were the patients with hypotropia in the range of 20-24 Δ

Conclusion: Knapps procedure should be graded according the amount of hypotropia. In patients where hypotropia is less than 20 Δ inferior rectus recession should be attempted first.