Surgical Correction of Dissociated Vertical Deviation

Background: There is currently no known cause for dissociated vertical deviation (DVD), an etiology-unknown eye motility condition. Traditionally, it has been described as a patient fixating on an object with one eye as the other eye drifts vertically.Aim: Three surgical procedures were tested for the correction of dissociated vertical deviation: anteriorization of the inferior oblique muscle (AIO), large superior rectus recession (SRR) (8 mm), and superior rectus recession with posterior fixation suture. The goals were to find the most effective, stable, and safest method.Subjects and methods: Patients from the pediatric and squint subspecialty clinics of the ophthalmology department at Al-Azhar University hospitals were enrolled in this prospective comparative interventional study beginning in June 2022 and continuing until January 2025. A total of 45 eyes were used in the study.Results: Manifest DVD shows a highly significant improvement in three groups (P=0.001), but latent DVD is not completely eliminated in all groups. The surgical success rate was 80%, 93.3%, and 86.7% in group-Ⅰ, Ⅱ, and group-Ⅲ at the 6th month postoperative, respectively. On long-term follow-up, the control of DVD was better with SR recession in conjunction with posterior fixation suture. Contrarily, SR recession with posterior fixation suture requires a higher level of surgical expertise and a more seasoned surgical assistant. Conclusion: While all three surgical methods were successful in reducing DVD up to 20 PD, the combination of SR recession and posterior fixation suture yielded better results than either SR recession alone or AIO for cases where the DVD was more than 20 PD. Additionally, management of DVD was better with SR recession and posterior fixation suture during long-term follow-up.