Residual incomitant DVD following large bilateral superior rectus recession

A recent survey of 25 experienced strabismus surgeons indicated that a very large superior rectus recession is the procedure of choice for DVD. We report a series of seven patients who exhibited a persistent DVD following large superior rectus recession. Furthermore, the DVD was markedly incomitant, much greater in adduction than in abduction. This residual DVD would mimic inferior oblique overaction on version testing, although proving to be purely DVD on critical observation. This "overaction" is apparently due to the marked weakening of the superior rectus and was not always predictive of the location and amount of persistent DVD. This previously unreported complication of large superior rectus recession is important to recognize so that alternative surgical approaches may be contemplated. It is hoped that more accurate observations and measurements both preoperatively and postoperatively will lead to a more orderly approach to DVD surgery.