Outcomes of Surgical Treatment in Cases of Dissociated Vertical Deviation

Abstract

Objectives: To investigate the results of different surgical techniques for treating cases of dissociated vertical deviation (DVD). Materials and Methods: A retrospective review of medical records was performed, including 94 eyes of 47 patients who had undergone bilateral superior rectus (SR) recessions (Group 1), bilateral SR recession with posterior fixation sutures (Group 2), or bilateral inferior oblique (IO) anterior transposition surgery (Group 3) for treatment of DVD. Nineteen patients underwent secondary procedures (SR weakening or IO anterior transposition) because of unsatisfactory results. The amount of the DVD in primary position before and after surgery, postoperative success ratios, and probable complications were evaluated. The Wilcoxon signed ranks test and chi-squared test were used for statistical evaluations. Results: In 69% of the 32 eyes in group 1, 65% of the 20 eyes in group 2, and 79% of the 42 eyes in group 3, satisfactory control of the DVD in primary position was achieved. All eyes undergoing both SR weakening and IO anterior transposition had a residual DVD of less than 5 prism diopters (pd). Of the total of 94 eyes, in 26 (89.6%) of 29 eyes that had a preoperative DVD angle of more than 15 pd [ten eyes from group 1, seven eyes from group 2, and nine eyes from group 3], the residual DVD angle after surgery was more than 5 pd. However, in the 65 eyes with preoperative DVD of 15 pd or less (21from Group 1, 12 from Group 2, and 32 from Group 3), the residual DVD angle after the operation was less than 5 pd. Two eyes of 2 patients had -1 limitation to elevation after surgery. Conclusion: Only IO anterior transposition or SR weakening surgery appear to be a successful surgical approaches in the management of patients with mild- and moderate-angle (≤15 pd) DVD. Weakening both the SR and IO muscles yield a greater success in the management of patients with large-angle (>15 pd) DVD. (Turk J Ophthalmol 2014; 44: 132-7)

Keywords

• Dissociated vertical deviation
• superior rectus
• recession
• posterior fixation suture
• inferior oblique
• anterior transposition