Treatment of Dissociated Vertical Deviation by Combined Recession–Resection of the Superior Rectus Muscle versus Recession with Posterior Fixation Suture

Abstract

Background: Management of dissociated vertical deviation (DVD) is still a matter of controversy in strabismus practice. Different surgical techniques are available, ranging from the weakening of the superior rectus or inferior oblique muscles to strengthening of the inferior rectus muscle, with variable success rates. Objective: To report the outcomes of correcting DVD by combined recession-resection of the superior rectus muscle and to compare the results with those of superior rectus muscle (SR) recession with posterior fixation sutures. Methods: The medical records of patients who had a surgical correction for DVD were retrospectively reviewed. Two groups of patients were identified; Group I (29 patients) was treated with the combined recession –resection of the SR and group II (37 patients) was treated by SR recession with posterior fixation sutures (Faden). Collected preoperative data included age, best-corrected visual acuity, presence of amblyopia, history of previous surgeries and angle of DVD. Operative data such as amount of SR recession and operative time were also extracted. The outcome measures taken at the final postoperative follow up visit included the surgical success rate which is identified as the percentage of patients with absent manifest DVD and the amount of residual latent deviation measured by prism cover test. Results: The mean follow-up period for all patients was 22.6 ±4.6 months. In the last follow-up visit, the surgical success rate was 76% in the combined recession-resection group and 73% in the faden group with no significant difference between both groups (p=0.8). No significant difference was found in the residual latent deviation in both groups as well. The recorded surgical time was significantly shorter in the combined recession- resection group (p<0.001). The reported complications included mild, temporary limitation of elevation without hypotropia in 5 patients (2 in group I (7%) and 3 patients in group II (8%)) with no significant difference between both groups (p=0.8). Conclusion: Combined recession-resection of SR is as effective as SR recession with posterior fixation suture in the management of DVD with the advantages of easier technique and less surgical time.