Surgical results in highly asymmetric dissociated vertical deviations

Area of Science:

• Ophthalmology
• Strabismus Surgery
• Pediatric Ophthalmology

Background:

• Dissociated vertical deviations (DVD) present significant challenges in surgical management, particularly in highly asymmetric cases.
• Pre-operative assessment of fixation preference is crucial, though often difficult in asymmetric DVD.
• Bilateral surgical approaches are frequently employed for asymmetric DVD due to lack of strong fixation preference.

Purpose of the Study:

• To evaluate the efficacy of surgical interventions for highly asymmetric dissociated vertical deviations (DVD).
• To compare the outcomes of different surgical techniques, including posterior fixation sutures alone versus combined with superior rectus recession.

Main Methods:

• A cohort of 13 patients with asymmetric DVD (moderate/large in one eye, small/latent in the fellow eye) underwent bilateral surgery.
• Surgical techniques included conventional superior rectus (SR) recession with posterior fixation sutures or posterior fixation sutures alone.
• Follow-up averaged eight months, with cure defined as elimination or latency of hyperdeviation.

Main Results:

• Five patients achieved a cure (elimination/latency of hyperdeviation).
• Eight patients developed moderate to large DVD in the previously less affected eye, with two experiencing manifest hypertropia postoperatively.
• Posterior fixation sutures alone for the small DVD eye were ineffective; combined SR recession and posterior fixation sutures showed better outcomes.

Conclusions:

• Surgical treatment of highly asymmetric DVD yields variable results.
• Posterior fixation sutures alone are insufficient for treating small or latent DVD.
• Combining superior rectus recession with posterior fixation sutures represents a more promising approach for managing asymmetric DVD.