Introduction: DVD is a rare, poorly understood eye motility disorder of unknown etiology. In socially unacceptable deviation, surgical treatment is an option. We present patients operated with three different surgical methods. Aim: To evaluate and compare different surgical approaches for treatment of dissociated vertical deviation (DVD). Methods: Total amount of 20 patients with DVD of ≥ 20 PD are operated with three different techniques on superior rectus (SR) muscle: Group I with preoperative angle of 20-30 PD was operated with 8 mm recession of SR, Group II with preoperative angle of ≥ 30 PD undergo 3 mm recession with posterior fixation on SR and Group III with preoperative angle of ≥ 30 PD undergo-splitting of SR muscle. Surgeries for associated horizontal deviations were performed before surgery for DVD. Follow up was three years. Results: In all cases amount of DVD deviation was significantly reduced. No binocularity was gained. Although hyperdeviation of affected eye was reduced in all patients, we didn't eliminate deviation completely. Despite smaller preoperative angle, residual angle was bigger (6-12 PD) in the patients in group I where only recession of SR was performed, compared to Group II and III where postoperative angle was 4-8 PD in both groups. Conclusion: There are no recommended guidelines for the surgical treatment of DVD and treatment is based more on the surgeon's experience than evidence based data. In our experience recession of the SR should be method of choice in the cases of smaller deviation. SR recession combined with posterior fixation suture and Y-splitting seems to be a safe and effective method for surgical treatment of unilateral DVD with bigger deviation angles. Y splitting with less surgical complications and increasing effect with time can be a good alternative to posterior fixation surgery.
Myopia is the most prevalent refractive error in the world and its incidence is increasing. Together with conservative methods of treatment, various surgical methods have been proposed. Corneal refractive surgery is probably the most accepted one. Laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and small incision lenticule extraction (SMILE) are suitable for treatment of myopia up to −8.00 D in the younger age group. For patients not suitable for corneal refractive surgery, lens-based procedures are available. Phakic intraocular lenses are suitable for patients younger than 45 years of age with high myopia or some other contraindications for corneal refractive surgery. For older patients, refractive lens exchange (RLE) with implantation of multifocal or monofocal intraocular lenses is gaining popularity.
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