Surgical results in highly asymmetric dissociated vertical deviations

The effect of surgery in highly asymmetric dissociated vertical deviations (DVD) was evaluated in 13 patients. All the patients had a moderate or large DVD (more than 15 PD) in one eye with a latent or very small (less than 5 PD) DVD in the fellow eye. As there was no strong fixation preference in either of the two eyes of the patients before surgery, bilateral surgery was performed. Eleven patients underwent surgery which consisted of conventional (3-5 mm) superior rectus (SR) recession combined with posterior fixation sutures placed 13 mm from the original insertion in the eye with moderate or large DVD, with posterior fixation sutures alone in the eye with minimal or latent DVD. In the remaining two patients, bilateral conventional SR recessions were combined with posterior fixation sutures. The mean follow-up was eight months. A cure was defined as latency or elimination of the hyperdeviation and was noted in five patients, two of whom had undergone bilateral SR recessions with posterior fixation sutures. All the remaining eight patients developed a cosmetically unacceptable moderate or large DVD (more than 15 PD) in the eye that had a very small DVD prior to surgery, two of them having a manifest comitant hypertropia postoperatively in addition to the DVD, demonstrating overcorrections with the previously elevated eye now in a hypotropic position. Performing posterior fixation sutures alone to the eye with a very small DVD does not seem to be effective in the surgical treatment of DVD; combining posterior fixation sutures with a recession of the SR muscle seems to be a more reasonable approach.