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Factors influencing the development and severity of dissociated vertical deviation in patients with infantile
Kwang Hoon Shin1, Hae Jung Paik1
1Department of Ophthalmology, Gachon University, Gil Hospital, Incheon, Korea.
Insights
Early surgery for infantile esotropia, particularly before 24 months and for large deviations, reduces the risk of developing spontaneous dissociated vertical deviation (DVD). This finding is crucial for improving surgical outcomes in pediatric strabismus.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Surgery
Background:
- Infantile esotropia is a common childhood eye misalignment.
- Dissociated vertical deviation (DVD) is a potential complication following surgery for infantile esotropia.
- Understanding factors influencing DVD development is critical for optimizing surgical strategies.
Purpose of the Study:
- To identify factors associated with the development and severity of dissociated vertical deviation (DVD) after infantile esotropia surgery.
- To compare characteristics of patients with spontaneous DVD, latent DVD, and no DVD.
Main Methods:
- Retrospective review of 90 patients undergoing infantile esotropia surgery (1998-2011).
- Assessment of DVD development, severity, and onset.
- Comparison of surgical timing, esotropia angle, anisometropia, amblyopia, stereopsis, and prematurity history across DVD groups.
Main Results:
- DVD was detected in 58% of patients (n=52).
- Spontaneous DVD was significantly associated with later surgery (after 24 months) and larger esotropia angles (>60Δ).
- Later surgery (OR=8.23) and large-angle esodeviation (OR=6.32) were independent predictors for spontaneous DVD.
Conclusions:
- Surgical correction of infantile esotropia before 24 months of age is recommended.
- Addressing large-angle esodeviations concurrently may further reduce the incidence of spontaneous DVD.
- Timely and appropriate surgical intervention is key to minimizing postoperative complications like DVD.
Purpose:
To investigate the factors associated with the development and the severity of dissociated vertical deviation (DVD) in patients who underwent surgery for infantile esotropia.
Methods:
The medical records of consecutive patients who underwent surgery from March 1998 to December 2011 for infantile esotropia were reviewed retrospectively. The development, severity, and onset of DVD were assessed. Patients were divided into three groups: spontaneous, latent, and no DVD. The age at the time of the initial surgery, the angle of deviation of esotropia, anisometropia, amblyopia, stereopsis measured at the final visit, and history of prematurity were compared.
Results:
A total of 90 patients were included. DVD was detected in 52 (58%). Of these, 34 patients demonstrated spontaneous DVDs and 18 showed latent DVDs. In the spontaneous DVD group, 71% underwent surgery after 24 months and 50% had a large angle of esodeviation (>60(Δ)), compared to the latent DVD group, in which 22% underwent later surgery and 11% had large-angle esodeviations (P < 0.001 and P = 0.002, respectively), and the no DVD group, in which 16% underwent later surgery and 13% had large-angle esodeviations (P < 0.001 each). Multivariate logistic regression analysis between groups revealed that later surgery (OR = 8.23; P < 0.001) and large-angle esodeviation (OR = 6.32; P = 0.003) were associated that greater development of spontaneous DVD.
Conclusions:
Surgical correction for infantile esotropia prior to 24 months of age, especially in cases with a large amount of esodeviation, decreased the incidence of spontaneous DVD.
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