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 ...