Abstract
Abstract: :
Purpose:To compare between superior rectus recession and four oblique technique for dissociated vertical deviation with «A» syndrome. The dissociated vertical deviation (DVD) is a component of dissociated strabismus characterized by no observation of Hering’s law. The «A» syndrome (A) is characterized by an asymmetry because a divergence in the vertical’s downgaze against primary position and upgaze. Both pathologies have several treatments. Methods:Patients with an association of DVD and A, divided into two groups. Group 1 included 12 eyes treated with superior rectus recession (SRR). Group 2 included 27 eyes treated with 4 obliques technique (inferior oblique anterior transposition with superior oblique fasciotenectomy (4 obs)). The results were compared on the efficacy in decreasing the DVD manifestation, on the grade of A’s magnitude, the obliques’ function, the vertical incomitances, the supraduction limitation, the aesthetic appearance, lateral incomitances, and induced strabismus Results:Both techniques were effective against DVD. The DVD of «+» was present in 42.9% during the first week and 14.3% three months later in the 4 obs, while in the SRR was 33.3% at the first week and 0% at three months. The DVD of «++» have, in the 4 obs, a presentation at the first week of 66.7% and 22.2% at 3 months, and in the SRR group 57.14% seven days after the surgery and 28.57% 3 months later. The SRR had less vertical incomitances and supraduction limitations. The A decrease considerably in both SRR (29.5D to 5D) and 4 obs (31.8D to 0.62D),with better results in the 4 obs one. There were no cases of secondary strabismus in the SRR group, and two cases of Brown syndrome and one with a primary-secondary deviation in the 4 obs one. In the superior oblique overacting, only the 14.9% of the 4 obs were overacting three months after the surgery, against 8.33% of the SRR group at the same time. No one of the groups have an aesthetic problem. The «T» anisotropy was present in 7.4% in the 4 obs at the first week and 22.2% at three months, while in the SRR was of 33.3% in the first week and 16.67% three months later. 25.9% of the 4 obs group have a supraduction limitation, and none in the SRR group, and 14.3% in the 4 obs have a hiper-hipotropy with none in the SRR groups at three months after the surgery. Conclusion:Both techniques are effective against DVD. By the fact that the 4 obs is an easy surgical procedure while SRR have a minor sequels, a suggestion of treat with 4 obs surgery the small DVD with a big A and with SRR the big DVD with small A was made.
Keywords: 353 clinical (human) or epidemiologic studies: outcomes/complications • 406 eye movements • 591 strabismus: treatment