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Aim: To show that the classic Knapp procedure when used for treatment of monocular elevation deficiency may not correct it completely especially when associated with pseudoptosis and to suggest a treatment option.
Methods: Thirteen patients (2 to 6 years) with congenital monocular elevation deficiency (MED) were studied. All patients had hypotropia, pseudoptosis, absent elevation above the primary position and negative forced duction test of the affected eye. Medial and lateral rectus muscles were elevated via Knapp procedure. Two months later, the inferior rectus muscle of the non-affected eye was resected 6 m for three patients and tucked for the other two patients. On follow up, vertical deviation mar nal reflex dis ance were recorded after each procedure.
Results: After Knapp procedure, hypotropia was moderately improved and pseudoptosis appeared worse in three of the five patients. On the other hand, a good lid height and an improvement in hypotropia were achieved after resecting the contralateral inferior rectus muscle for all patients.