Surgical management of dissociated vertical deviation associated with A-pattern strabismus

Area of Science:

• Ophthalmology
• Strabismology
• Surgical Ophthalmology

Background:

• Dissociated vertical deviation (DVD) often coexists with pattern strabismus and oblique muscle dysfunction.
• Identifying bilaterality, symmetry, and lateral incomitance is crucial for surgical planning in DVD.
• This study focuses on comparing surgical techniques for DVD associated with A-pattern strabismus.

Purpose of the Study:

• To compare the efficacy of three different surgical approaches for treating DVD in patients with A-pattern strabismus.
• To evaluate the impact of surgical technique on the correction of A-pattern, vertical deviation, and DVD asymmetry.

Main Methods:

• Retrospective review of 40 patients with DVD and A-pattern strabismus.
• Surgical procedures included: bilateral superior rectus muscle recession; bilateral superior rectus recession with superior oblique posterior tenectomy; and bilateral superior oblique temporal tenotomy with inferior oblique recession.

Main Results:

• Bilateral superior rectus recession corrected smaller A patterns (7Δ) and significant asymmetry (>4Δ).
• Combined superior rectus recession and superior oblique tenectomy addressed moderate A patterns (17Δ).
• Oblique muscle surgery (temporal tenotomy and inferior oblique recession) was most effective for large A patterns (30Δ).

Conclusions:

• The magnitude of the A pattern and DVD symmetry are critical factors in surgical decision-making.
• Bilateral superior rectus muscle recession is suitable for small A patterns and significant asymmetry.
• Larger A patterns necessitate superior oblique weakening or combined oblique muscle procedures.