Unilateral superior rectus recession for the treatment of dissociated vertical deviation

The management of dissociated vertical deviation (DVD) is an unsettled issue. Several authors have advocated bilateral superior rectus recession for all patients with DVD unless a dense amblyopia is present in the nonfixating eye. Our experience suggested that DVD was being successfully treated with unilateral bilateral superior rectus recession. We reviewed the charts of 57 patients who underwent graded unilateral superior rectus recession and 10 patients who had bilateral superior rectus recession for the treatment of DVD. DVD, a manifest deviation, was considered as distinct from occlusion hyperphoria, a latent deviation present only under cover. Of the patients who underwent unilateral superior rectus recession, only six developed a significant (14 prism diopters or more) DVD in the unoperated eye. The presence of any DVD in the unoperated eye appeared to be predictive of an unacceptable postoperative deviation (15 times greater chance, P less than .001). Patients with an occlusion hyperphoria in the unoperated eye showed no increased propensity to develop a significant DVD following surgery. The results of bilateral surgery were disappointing. Eight of ten patients had residual DVD in one or both eyes of 10 delta or greater. Our results suggest that unilateral surgery is an effective treatment of DVD in patients with a manifest deviation in only one eye. Although neither unilateral nor bilateral surgery was entirely satisfactory for the treatment of bilateral DVD, we recommend bilateral superior rectus recession for these patients.