Comparison of surgical methods in the treatment of dissociated vertical deviation

The effectiveness of 3- to 5-mm recession of the superior rectus muscle with and without posterior fixation sutures was compared with 7- to 9-mm superior rectus muscle recessions in 228 patients with dissociated vertical deviation. We examined the patients at intervals ranging from six months to three years, and the results were classified as corrected, improved, or failed. Superior rectus muscle recessions of 3 to 5 mm were the least successful treatment. When 3- to 5-mm recession was combined with posterior fixation, the short-term results were more encouraging but the failure rate after three years was nearly the same in both groups (59% and 55%, respectively). The best results (P = .021) were achieved with 7- to 9-mm recessions. After three years the dissociated vertical deviation of most patients treated with this technique remained corrected or improved.