Factors influencing the development and severity of dissociated vertical deviation in patients with infantile esotropia

Abstract

To investigate the factors associated with the development and the severity of dissociated vertical deviation (DVD) in patients who underwent surgery for infantile esotropia. 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. 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. Surgical correction for infantile esotropia prior to 24 months of age, especially in caseswitha large amount of esodeviation, decreased the incidence of spontaneous DVD.