Dissociated vertical deviation: an asymmetric condition treated with large bilateral superior rectus recession

Area of Science:

• Ophthalmology
• Strabismus Surgery
• Pediatric Eye Conditions

Background:

• Dissociated vertical deviation (DVD) is a common strabismus condition.
• Surgical management of DVD often involves recessing the superior rectus muscles.
• Large recessions have been explored for efficacy and safety in DVD treatment.

Purpose of the Study:

• To evaluate the effectiveness and safety of bilateral superior rectus recessions for treating dissociated vertical deviation (DVD).
• To assess the surgical outcomes in patients with asymmetric DVD and associated hypertropia.
• To determine optimal surgical strategies for DVD, including asymmetrical recessions when indicated.

Main Methods:

• Performed bilateral superior rectus recessions (at least 10 mm) on 25 patients diagnosed with dissociated vertical deviation (DVD).
• Analyzed surgical outcomes, including effectiveness in correcting DVD, presence of undercorrection or overcorrection, and complications.
• Assessed patients with asymmetric DVD and those with coexisting unilateral hypertropia, noting specific surgical adjustments.

Main Results:

• Large bilateral superior rectus recessions were effective and safe for DVD, with slight undercorrection noted in all patients.
• No complications such as ptosis, upper lid retraction, or altered palpebral fissure width occurred.
• Forty percent of patients had asymmetric DVD with significant unilateral hypertropia, requiring asymmetrical surgical amounts; two needed reoperation for residual hypertropia.

Conclusions:

• Bilateral superior rectus recessions exceeding 10 mm are a safe and effective primary surgical approach for DVD.
• Asymmetric DVD with manifest hypertropia necessitates asymmetrical recessions, with a greater recession (over 15 mm) in the deviating eye.
• Unilateral surgery is reserved for cases of severe amblyopia where the operated eye is unlikely to achieve fixation.