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Abstract
Purpose
This study analyzed the outcome of unilateral superior rectus recession in patients with asymmetrical dissociated vertical deviation (DVD) in terms of effectiveness and influence on the fellow eye.
Methods
Medical records of 40 patients (40 eyes) who had undergone unilateral superior rectus recession for the treatment of asymmetrical DVD were retrospectively reviewed from February 1993 to March 2009. The minimum follow-up period was 1 year after the operation.
Results
The overall success rate in the operated eye was 97.5% at 12 months and 90% at the last follow-up. However, a DVD larger than 10 PD developed in the fellow eye in 20% (8) of the patients. In patients who preoperatively had DVD in their fellow eyes, 50% developed DVD postoperatively in their fellow eyes. In patients who preoperatively did not have DVD in their fellow eyes, 14.7% developed DVD postoperatively in their fellow eyes. Furthermore, the angle of the DVD in the fellow eye increased with the surgical dosage.
Conclusions
Unilateral SR recession is effective in patients with asymmetrical DVD. However, a high incidence rate of DVD in the fellow eye should be considered, especially when preoperatively there is a small DVD in the fellow eye or a large DVD angle in the operated eye, whenever monocular superior rectus recession surgery is performed.
References
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Figure 1.
Relationship between the amount of superior rectus recession and the amount of DVD in the fellow eye at the last follow-up (r = 0.419, p = 0.007). DVD = dissociated vertical deviation; PD = prism diopters; SR = superior rectus.
Table 1.
Demographics of patients undergoing unilateral superior rectus recession
| Characteristic | Values |
|---|---|
| Number of patients | 40 |
| Gender (M:F) | 20:20 |
| Age at initial diagnosis (yrs) | 7.6 ± 9.0 (0–41) |
| Age at surgery (yrs) | 11.2 ± 8.9 (4–42) |
| Follow-up period (mons) | 49.1 ± 40.0 (12–170) |
Table 2.
Preoperative deviation angle
| DVD (PD) | No. of patients (%) |
|---|---|
| <10 | 3 (7.5) |
| 10–14 | 12 (30.0) |
| 15–19 | 7 (17.5) |
| 20–25 | 15 (37.5) |
| >25 | 3 (7.5) |
| Total | 40 (100) |
Table 3.
Surgical dosage table for patients with dissociated vertical deviation
| DVD (PD) | SR recession (mm) |
|---|---|
| <10 | 5 |
| 10–14 | 6 |
| 15–19 | 7 |
| 20–25 | 8 |
| >25 | 9 |
Table 4.
Postoperative results of DVD in the operated eye
| Postoperative DVD (PD) | No. of patients at 1 year (%) | No. of patients at the last F/U (%) |
|---|---|---|
| 0–4 | 35 (87.5) | 29 (72.5) |
| 5–9 | 4 (10) | 7 (17.5) |
| 10–14 | 0 (0) | 3 (7.5) |
| ≥15 | 1 (2.5) | 1 (2.5) |
Table 5.
Postoperative results of DVD in the fellow eye
| Fellow eye DVD (PD) | No. of patients at 1 year (%) | No. of patients at the last F/U (%) |
|---|---|---|
| ≤4 | 1 (2.5) | 1 (2.5) |
| 5–9 | 5 (12.5) | 4 (10) |
| 10–14 | 3 (7.5) | 2 (5) |
| ≥15 | 4 (10) | 6 (15) |
Table 6.
Postoperative results of patients who had DVD in the fellow eye preoperatively
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