Abstract

Introduction: Dissociated Vertical Deviation (DVD) is part of the dissociated strabismus group, with a cortical origin and related to epileptic diseases. The surgical techniques described for its treatment focus on the limitation of elevation by different mechanisms. Inhibition surgery limits elevation through the Sherrington Law and the control system from the cortical areas.

Case Description: In this paper, 3 male patients between ages 9 and 10 years are described with a brain injury detected by computerized axial tomography scan, secondary cerebral palsy and a history of perinatal asphyxia, spontaneous DVD of 2 to 4 crosses, with asymmetric elevation which underwent bilateral symmetric recessions of 6 mm in the inferior recti muscles, and the cases were associated with an exotropia that was treated with recessions of both lateral recti.

Important improvement was noticed for the vertical strabismus down to one cross or less since day one post-op and still remains after two years of follow up.

Discussion: Inhibition surgery is effective in limiting elevation as a treatment for DVD in children with neurological damage and poor fusion potential. Hence, we believe that an inhibitory effect is triggered from the system that controls ocular movements at the cortex.

Keywords: Dissociated Vertical Deviation (DVD); Strabismus; Epileptic Diseases

References

1. Arroyo Yllanes ME. “Criterio diagnóstico y terapéutico en los estrabismos disociados”. Acta Estrabológica 39.2 (2010): 175-190.
2. Arrollo-Yllanez MEA., et al. “Comportamiento del estrabismo en pacientes con parálisis cerebral infantile”. Cirugía y Cirujanos 67.6 (1999): 208-211.
3. Helveston EM. “Dissociated vertical deviation: a clinical and laboratory study”. Transactions of the American Ophthalmological Society 78 (1980): 734-779.
4. Nishitani N., et al. “Cortical visuomotor integration during eye pursuit and eye-finger pursuit”. Journal of Neuroscience 19.7 (1999): 2647-2657.
5. Gallegos-Duarte M. “Respuesta cortical paradójica durante la foto estimulación intermitente”. Cirugía y Cirujanos 73.3 (2005): 161-165.
6. Gallegos-Duarte M., et al. “Desviación disociada. Un estrabismo de origen cortical”. Cirugía y Cirujanos 75.4 (2007): 237-243.
7. Gallegos-Duarte M., et al. “Brain Mapping Alterations in Strabismus”. Brain Research Journal 1.4 (2007): 287-337.
8. Magoon E., et al. “Dissociated vertical deviation: an asymmetric condition treated with large bilateral superior rectus recession”. Journal of Pediatric Ophthalmology and Strabismus 19 (1982): 152-156.
9. Elliot RL and Nankin SJ. “Anterior transposicion of the inferior oblique”. Journal of Pediatric Ophthalmology and Strabismus 8 (1981): 35-38.
10. Romero-Apis and Castellanos-Bracamontes. “Cirugía inervacional e inhibicional para desviación vertical disociada”. Acta Estrabológica 2 (2015): 143-148.