Different Surgical Approaches for treatment of isolated dissociated vertical deviation without inferior oblique overaction

Eur J Ophthalmol. 2022 Nov;32(6):3237-3243. doi: 10.1177/11206721221080000. Epub 2022 Feb 14.

Abstract

Purpose: To report the surgical results on superior rectus recession (SRR) and inferior oblique anterior transposition (IOAT) for cases with isolated bilateral dissociated vertical deviation(DVD)without inferior oblique overaction (IOOA).

Methods: A retrospective review was conducted for cases with isolated bilateral DVD without IOOA who were surgically treated using either bilateral SRR (SRR group) or IOAT (IOAT group). Pre- and post-operative ocular motility, ocular alignment, amount of DVD and complications were compared between the two groups.

Results: Records from 37 cases were reviewed. Preoperative levels of DVD (M ± SD) in the SRR group (N = 18) of 19.88 ± 6.72 prism diopter (PD) in the right eye and 19.54 ± 5.64 PD in the left eye, were reduced to 4.94 ± 7.26 PD and 4.11 ± 3.91 PD respectively after surgery (P<0.0001 for both). Preoperative levels of DVD (M ± SD) in IOAT group (N = 19) of 15.89 ± 6.35 PD in the right eye and 18.58 ± 9.27 PD in the left eye, were reduced to 3.42 ± 4.49 PD and 3.42 ± 4.88 PD respectively after surgery (P<0.0001 for both). Inferior oblique (IO) muscle function remained normal after surgery. Overall, outcomes within the SRR group revealed that 10 patients showed a complete resolution of their condition, 6 effective responses and 2 failures. In the IOAT group, 13 patients showed a complete resolution of their condition, 5 effective responses and 1 failure. There were no statistically significant differences between the two groups (Z = 0.48).

Conclusion: SRR and IOAT were both effective in treating isolated DVD without IOOA with similar satisfactory results obtained for both procedures.

Keywords: Dissociated vertical deviation; inferior oblique anterior transposition; strabismus; superior rectus recession; surgery.

MeSH terms

  • Humans
  • Ocular Motility Disorders* / surgery
  • Oculomotor Muscles / surgery
  • Ophthalmologic Surgical Procedures / methods
  • Orbital Diseases* / surgery
  • Retrospective Studies
  • Strabismus* / surgery
  • Treatment Outcome
  • Vision, Binocular / physiology