Double Elevator Palsy, Subtypes and Outcomes of Surgery

To describe the clinical manifestations of subtypes of double elevator palsyand to report the outcomes of surgery in these patients.methods: this retrospective study was conducted on hospital records of patients withdouble elevator palsy at labbafinejad medical center over a ten-year period from 1994to 2004. patients were classified into three subgroups of primary elevator muscle palsy(9 subjects), primary supranuclear palsy with secondary inferior rectus restriction (4subjects) and pure inferior rectus restriction (7 subjects) according to forced duction test(fdt), force generation test (fgt) and bell's reflex . patients in the first groupunderwent knapp procedure, the second group received knapp procedure and inferiorrectus recession simultaneously and in the third group vertical recess-resect or mereinferior rectus recess operation was performed. success was defined as final residualdeviation ≤5 pd and ≥25% improvement in restriction after all operations.results: overall 20 subjects including 10 male and 10 female patients with mean age of12.6±9.3 (range 1.5-32) years were operated during the mentioned period which included9 cases of primary elevator muscle palsy, 4 patients with primary supranuclearpalsy and secondary inferior rectus restriction, and 7 subjects with pure inferior rectusrestriction. mean follow-up was 22.0±20.0 (range 3-63.5) months. mean pre and postoperativedeviation was 32.0±8.0 pd and 3.8±8.0 pd (p