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Volume 48, 1998, p. 3033

Surgery for Dissociated Vertical Deviation: For Superior Rectus Recession (Abstract)
H. Sprague Eustis, M.D.

Although dissociated vertical deviation (DVD) represents one of the most common hyper-deviations encountered by pediatric ophthalmologists, it is poorly understood. DVD is most frequently seen in association with infantile esotropia (60 to 80% of patients) but it is also found in 8.79% of patients with exotropia and 7.2% of patients with hypertropia. The clinical presentation varies: some patients manifest a purely vertical deviation, others demonstrate horizontal or torsional components, and others a combination of all three components. The difficulty in dealing with DVD is compounded by the difficulty of accurately measuring the deviation. Even with prism-under-cover testing, the deviation is highly variable, without a clear end point.

When evaluating patients with DVD, surgeons should be cognizant of confounding factors that will change the treatment. Incomitance in side-gaze should suggest oblique dysfunction. If the inferior oblique is overacting in association with DVD, a superior rectus recess will accentuate the inferior oblique overaction and cause worsening of the V-pattern, In this situation, an inferior oblique anteriorization is the procedure of choice.