Interventions for dissociated vertical deviation

Abstract

Background The term “strabismus” describes misalignment of the eyes. One or both eyes may deviate inward, outward, upward, or downward. Dissociated vertical deviation (DVD) is a well-recognized type of upward drifting of one or both eyes, which can occur in children or adults. DVD often develops in the context of infantile- or childhood-onset horizontal strabismus, either esotropia (inward-turning) or exotropia (outward-turning). For some individuals, DVD remains controlled and can only be detected during clinical testing. For others, DVD becomes spontaneously “manifest” and the eye drifts up of its own accord. Spontaneously manifest DVD can be difficult to control and often causes psychosocial concerns. Traditionally, DVD has been thought to be asymptomatic, although some individuals have double vision. More recently it has been suggested that individuals with DVD may also suffer from eyestrain. Treatment for DVD may be sought either due to psychosocial concerns or because of these symptoms. The standard treatment for DVD is a surgical procedure; non-surgical treatments are offered less commonly. Although there are many studies evaluating different management options for the correction of DVD, a lack of clarity remains regarding which treatments are most effective. Objectives The objective of this review was to determine the effectiveness and safety of various surgical and non-surgical interventions in randomized controlled trials of participants with DVD. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2015, Issue 8), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to August 2015), EMBASE (January 1980 to August 2015), PubMed (1948 to August 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to August 2015), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) (last searched 3 February 2014), ClinicalTrials.gov (www.clinicaltrials.gov), and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 3 August 2015. Selection criteria We included randomized controlled trials (RCTs) of surgical and non-surgical interventions for the correction of DVD. Data collection and analysis We used standard procedures expected by Cochrane. Two review authors independently completed eligibility screening, data abstraction, ‘Risk of bias’ assessment, and grading of the evidence. Main results We found four RCTs eligible for inclusion in this review (248 eyes of 151 participants between the ages of 6 months to 22 years). All trials were assessed as having unclear risk of bias overall due to insufficient reporting of study methods. One trial was conducted in Canada and compared anteriorization of the inferior oblique muscle with resection versus anteriorization of the inferior ...

Vertikal Kaymalarda Orta Dönem Şaşılık Cerrahisi Sonuçlarımız

“…Different treatment methods such as superior rectus recession (SRR), chemodenervation, anterior transposition of the inferior oblique muscle, resection of the inferior rectus muscle and their combined surgeries are recommended in the surgical treatment of the DVD. 4,16 Akar et al compared the surgical results and possible complications of three surgical techniques namely SRR, posterior fixation suture surgery with the anterior transposition surgery and the anterior transposition surgery in DVD. 17 In this study, 22 (69%) out of 32 eyes who underwent SRR surgery were considered successful (<5 prism diopter), while residual DVD was observed in other patients.…”

“…The approach in vertical strabismus is commonly case-bycase. [3][4][5][6] Our aim was to analyze our cases with vertical deviations and compare our outcomes among vertical strabismus cases with various etiologies.…”

Unilateral Inferior Oblique Anterior Transposition for Asymmetric Dissociated Vertical Deviation with Unilateral Inferior Oblique Over-action

“…It was an abnormal vertical movement of eye ball, contradictory with the role of nerve domination [1]. When DVD coexisted with inferior oblique over-action (IOOA), inferior oblique anterior transposition (IOAT) was recommended [2][3][4][5][6][7]. It was an ideal method to reduce the strength of inferior oblique and restrict floating phenomenon of DVD synchronously.…”

Unilateral Inferior Oblique Anterior Transposition for Markedly Asymmetric Dissociated Vertical Deviation with Unilateral Inferior Oblique Over-action

“…It was considered to be an ideal method to reduce the strength of the inferior oblique muscle and simultaneously restrict the floating phenomenon of DVD. Most clinicians suggested that binocular DVD should be treated with binocular surgery, especially for symmetric DVD [3,5,7]. However, treatment decisions are more complex in asymmetric DVD, in which bilateral asymmetric [8,9,10] or unilateral [4] surgery may be considered.…”

“…DVD is usually bilaterally. Asymmetric DVD is probably associated with unequal IOOA or superior rectus overaction[7]. The management of DVD is challenging for strabismus surgeons.…”