Surgical treatment of asymptomatic disseminated vertical deviation

Abstract

Objective To evaluate the efficiency of surgical treatment of asymmetric disseminated vertical deviation (DVD).Methods Fifteen cases with asymmetric DVD were summarized retrospectively.All clinical records,including sex,age,types of deviation,clinical features,surgical methods and clinical outcomes were analyzed.All patients were followed up for 3 months to 2 years.Results Six cases were diagnosed only as DVD,while the other 9 cases combined with other strabismus.Five cases had only monocular involvement,while 3 cases were treated by recession of superior rectus muscle and 2 cases by myectomy combined with anterior transposition of inferior oblique; 10 cases had both eyes affected,while 6 cases were treated by recession of superior rectus muscle from 3.5 mm to l0 mm and 4 cases by myectomy combined with anterior transposition of inferior oblique.According to the difference of hypertropia and inferior oblique muscles hyperfunction,different myectomy of inferior oblique muscle was done and fixed it at the temporal rectus inferior 1mm and under rectus inferior 1mm.After surgery,12 patients were orthotropia in primary position.A satisfactory aspect was obtained and there was no occlusion hycrtropia.However,1 patient who underwent unilateral superior rectus recession,developed a significant DVD in the un-operated eye,1 eye appeared deficient up gaze in adduction.Conclusions Asymmetric surgery is effective to treat asymmetric DVD,when DVD combined with inferior oblique overaction,myectomy combined with anterior transposition of inferior oblique is preferred,if it is not,the recession of superior rectus should be the first choice. Key words: Dissociated vertical deviation; Ophthalmologic surgical procedures; Oculomotor muscles