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Dissociated vertical deviation: what is the most effective surgical approach?

In a retrospective study on 42 patients who had surgery between 1982 and 1990, the immediate as well as the long-term effect of three different surgical procedures on the dissociated vertical deviation (DVD) was studied. The procedures were: Faden operation of Cüppers of the superior rectus muscle 12 to 14 mm posterior to its insertion (10 patients); Faden operation of the superior rectus muscle 12 to 14 mm posterior to its initial insertion combined with a 3-millimeter recession of the muscle (7 patients); and large recession of the superior rectus muscle of 10 mm in a hang-loose technique (25 patients). The initial effect on the DVD was similar in the Faden group and in the group of the large recession. However, the long-term effect of the Faden operation was clearly superior to the large recessions. The Faden operation must be combined with a recession of the superior rectus muscle of at least 3 mm to avoid undercorrections if the original angle of deviation is larger than 14 prism diopters. The results are compared with those of other authors.