This paper reports the results of surgery for supranuclear monocular elevation deficiency. Contralateral superior rectus maximal recession was undertaken without interfering with the superior oblique tendon position, transection of the superior oblique to the superior rectus frenulum and directly suturing the muscle to sclera 9-10.5mm from the original insertion. This was a retrospective review of five cases. Abnormal head position and alignment in primary position improved in all cases. Pseudoptosis also improved but was not eliminated. The mean age at surgery was 5.3 years. Mean superior rectus recession was 9.7mm. Mean follow-up was 4.8 years. The average surgical effect was 21PD of vertical deviation. The authors propose this technique as a simple and reliable alternative surgical method compared with a Knapp procedure with potential for less complications and with the option for further surgery if required. 

Surgery for supranuclear monocular elevation deficiency.
Struck MC, Larson JC.
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Fiona Rowe (Prof)

Institute of Population Health, University of Liverpool, UK.

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