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Binocular Vision & Diagnosis and Surgical Treatm ent of Dissociated Horizontal Deviation Strabism us FIRST Quarter of 2011
Strabology Quarterly© S. Gam io, M D Volum e 26 (No.1)
A M edical Scientific e-Periodical Pages 43-50
Original Scientific Article
Diagnosis and Surgical Treatment of
Dissociated Horizontal Deviation Strabismus
SUSANA GAMIO, M.D.
from the Ricardo Guitierrez Children’s Hospital, Buenos Aires, Argentina.
ABSTRACT: Purpose: Obtaining satisfactory binocular alignment in patients with Dissociated
Horizontal Deviation (DHD) requires a proper diagnosis and a specific surgical strategy.
Clinical characteristics, surgical treatment and the results obtained in 20 patients with DHD are
reported with a mean of 35 months postsurgical follow up.
Patients and Methods: Retrospective record review of patients with DHD who underwent
surgery between 2000 and 2007. Patient data were recorded, including age, sex, history of prior
surgery, visual acuity, pre-operative angle with each eye fixing, Reversed Fixation Test (RFT)
when available, type of operation performed, and final binocular alignment.
Results: Twenty patients were identified, mean age 11.7 years old, all of them with age
< 12 months at the time of strabismus onset. Ten of them had had prior surgery for congenital
esotropia. Nine showed exotropia (XT), 9 esotropia (ET) and 2 had ET when fixing with OS and
XT when fixing with OD. All of them also had an associated Dissociated Vertical Deviation
(DVD). Seven patients had amblyopia in the non-dominant eye. Six patients underwent a single
operation, 13 underwent 2 operations and 1 needed 3 surgeries to obtain satisfactory binocular
alignment.
Conclusions: Patients with DHD also exhibit bilateral and, very often, asymmetric DVD.
Therefore, a surgical plan for both the horizontal and vertical dissociation drift of the eyes is
needed. Bilateral surgery is almost always necessary, even in cases with a strong fixation
preference, in order to obtain satisfactory binocular alignment.
Received for consideration June 14, 2010; Accepted for publication July 6, 2010
Correspondence: email: susanagamio@gmail.com