Superior Rectus Recession With Y-splitting for Correction of Dissociated Vertical Deviation: A Prospective Study

Purpose: To evaluate the effect of recession with Y-splitting of the superior rectus muscle (SR) on correction of dissociated vertical deviation (DVD). Methods: Twelve consecutive patients with manifest DVD greater than 10 prism diopters (PD) received 7-mm SR recession with Y-splitting, with concurrent treatment of any horizontal deviation. Preoperative and postoperative evaluation of ductions and versions, ocular deviation and pattern was done. A successful outcome was considered as 0 to 6 prism diopters (PD) of vertical and 0 to 10 PD of horizontal deviation. Results: Surgery was performed on 19 SR muscles of 12 patients. Successful correction of DVD was achieved in all operated eyes (100%) after a mean follow-up of 6.9 ± 4.05 months. DVD became manifest in the fellow eye in 2 of 5 patients following unilateral surgery. Hypotropia (that became occasional after amblyopia therapy) was seen in one eye after unilateral surgery. Mild SR underaction was seen in 2 eyes and marked underaction in 1 eye postoperatively. Y-pattern was documented in 2 cases, V-pattern in 1 case, and X-pattern in 1 case postoperatively. Conclusions: SR recession with Y-splitting could be a promising option for correction of DVD. Bilateral surgery is advocated even if unilaterally manifest. Further studies on larger series of patients are recommended to consolidate these preliminary results.