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. 2019 Dec;73(6):386-390.
doi: 10.5455/medarh.2019.73.386-390.

Different Surgical Approaches for Treatment of Dissociated Vertical Deviation (DVD)

Ivana Mravicic  1 , Maja Pauk Gulic  1 , Ante Barisic  1 , Alma Biscevic  2 , Melisa Ahmedbegovic Pjano  2 , Ajla Pidro  2
Affiliations

Different Surgical Approaches for Treatment of Dissociated Vertical Deviation (DVD)

Ivana Mravicic et al. Med Arch. 2019 Dec.

Abstract

Introduction: DVD is a rare, poorly understood eye motility disorder of unknown etiology. In socially unacceptable deviation, surgical treatment is an option. We present patients operated with three different surgical methods.

Aim: To evaluate and compare different surgical approaches for treatment of dissociated vertical deviation (DVD).

Methods: Total amount of 20 patients with DVD of ≥ 20 PD are operated with three different techniques on superior rectus (SR) muscle: Group I with preoperative angle of 20-30 PD was operated with 8 mm recession of SR, Group II with preoperative angle of ≥ 30 PD undergo 3 mm recession with posterior fixation on SR and Group III with preoperative angle of ≥ 30 PD undergo-splitting of SR muscle. Surgeries for associated horizontal deviations were performed before surgery for DVD. Follow up was three years.

Results: In all cases amount of DVD deviation was significantly reduced. No binocularity was gained. Although hyperdeviation of affected eye was reduced in all patients, we didn't eliminate deviation completely. Despite smaller preoperative angle, residual angle was bigger (6-12 PD) in the patients in group I where only recession of SR was performed, compared to Group II and III where postoperative angle was 4-8 PD in both groups.

Conclusion: There are no recommended guidelines for the surgical treatment of DVD and treatment is based more on the surgeon's experience than evidence based data. In our experience recession of the SR should be method of choice in the cases of smaller deviation. SR recession combined with posterior fixation suture and Y-splitting seems to be a safe and effective method for surgical treatment of unilateral DVD with bigger deviation angles. Y splitting with less surgical complications and increasing effect with time can be a good alternative to posterior fixation surgery.

Keywords: Strabismus; amblyopia; ocular motility disorders; vision tests.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1.
Figure 1.. Patient with DVD
See this image and copyright information in PMC

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References

    1. Bielschowsky A. Die einseitigen und gegensinnigen (“dissozierten”) Verikalbewegungen der Augen. Graefes Arch Ophthalmol. 1931;125(1):493–553.
    1. Brodsky MC. Dissociated vertical divergence: a righting reflex gone wrong. Arch Ophthalmol. 1999;117(9):1216–1222. - PubMed
    1. Guyton LD, Cheeseman EW, Ellis FJ, et al. Dissociated vertical deviation: An exaggerated normal eye movement used to damp cyclovertical nystagmus. Trans Am Ophthalmol Soc. 1998;96(1):389–429. - PMC - PubMed
    1. Ten Tusscher MP, van Rijn RJ. A hypothetical mechanism for DVD: unbalanced cortical input to subcortical pathways. Strabismus. 2010;18(3):98–103. - PubMed
    1. Loba P, Broniarczyk-Loba A. Difficulties in diagnosis and treatment of dissociated vertical deviation (DVD) Part I. Klin Oczna. 2007;109(7):356–358. - PubMed

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