001, tables 1,​,22 and ​and33). Table 1 Surgical results of the patients undergoing the Knapp procedure Table 2 Surgical results of the patients undergoing IRR Table 3 Surgical results of the patients undergoing combined procedure The mean postoperative vertical deviation was 6.11±7.9 PD. Compared to preoperative measurements, there was a mean correction of 19.7 PD in the

amount of hypotropia in primary gaze position. Discussion In this case series, we performed different Inhibitors,research,lifescience,medical surgical procedures based on the results of the FDT in patients with MED and evaluated the results based on ocular alignment in primary position. The pathophysiology of MED is poorly understood. The early description of this condition was thought to be due to a combination of SR and inferior oblique muscle palsy (called double elevator palsy). Studies have shown that only 30% of cases are caused by this problem, and the FDT has demonstrated that 70% is caused by IR restriction.5 Magnetic resonance imaging (MRI) Inhibitors,research,lifescience,medical may be a useful adjunct to saccadic velocity

assessment in differentiating between primary IR restriction, primary SR paresis, and congenital supranuclear elevation deficiency.6 In our study, MED had similar predilection for the right Inhibitors,research,lifescience,medical eye and left eye involvement: 9 patients had right eye and 9 had left eye involvement. A predilection to right side involvement has been reported in MED in the series reported by Ziffer et al.7 and Kucak and co-workers.8 On the other hand, Khawam and Younis9 and also Bagheri et al.10 reported more instances of left eye involvement. Inhibitors,research,lifescience,medical Considering the mentioned studies and ours, it seems that the laterality of the condition provides no particular diagnostic information. The

goal of surgery in MED associated with ptosis or pseudoptosis is the management of combined hypotropia and blepharoptosis. For surgical correction of MED, the procedure of choice is determined by the FDT, which ascertains whether the cause is Linsitinib cost paretic or restrictive. In the presence of SR palsy (paretic form), the procedure employed is a Knapp transposition. The transposition procedure is not recommended Inhibitors,research,lifescience,medical in the presence of IR restriction. Therefore, it is important to perform FDT prior to surgery. In our series, Tryptophan synthase the mean amount of correction with the Knapp procedure alone was 20.0 PD. In his original work, Knapp3 reported 15 patients with MED and good results were obtained in 14 out of the 18 patients (93%). Correction of hypotropia in his study ranged from 21 to 55 PD with a mean of 38 PD. Others have found similar amounts of correction. Barsoum-Homsy11 observed an average correction of 31.7 PD and Watson12 in his series observed a mean correction of 30.5 PD after the Knapp procedure. Cooper and Greenspan13 reported 26.6 PD correction of hypotropia after this procedure. Scott14 performed the Knapp procedure in 19 patients and observed 21.1 PD corrections. Bandyopadhyay et al.15 reported a correction of 29.4 PD of vertical deviation.