Difficulties in diagnosis and treatment of dissociated vertical deviation (DVD). Part II – own experiences

Summary
Oblique muscles motility disorders may influence the magnitude of dissociated vertical deviation (DVD), resulting in greater vertical deviation in abduction and smaller in adduction. The diagnosis of this pattern of dissociation is essential for the selection of appropriate surgical management.

Purpose
The aim of this study was to assess optimal diagnostic and treatment procedures in patients with incomitant dissociated vertical deviation, superior oblique overaction and esotropia

Patients and methods
Five patients with the constellation of esotropia, bilateral superior oblique overaction, A –pattern, and incomitant dissociated vertical deviation are presented. In each case the magnitude of vertical deviation was greater in abduction and minimal or absent in adduction. Four patients underwent asymmetric bilateral superior rectus recessions and partial tenotomy of the posterior and middle fibers of superior oblique tendons. In one case additional surgery of horizontal muscles was performed.

Results
n all cases the A–pattern, DVD was markedly reduced or eliminated, and comitancy was achieved.

Conclusions
Recognition of the described pattern is important in selecting appropriate surgical management. Asymmetric bilateral superior rectus recessions and partial tenotomy of the posterior and middle fibers of superior oblique tendons is useful in reducing the A – pattern and incommitancy in DVD.