This study analyzed the outcome of unilateral superior rectus recession in patients with asymmetrical dissociated vertical deviation (DVD) in terms of effectiveness and influence on the fellow eye.

Medical records of 40 patients (40 eyes) who had undergone unilateral superior rectus recession for the treatment of asymmetrical DVD were retrospectively reviewed from February 1993 to March 2009. The minimum follow-up period was 1 year after the operation.

The overall success rate in the operated eye was 97.5% at 12 months and 90% at the last follow-up. However, a DVD larger than 10 PD developed in the fellow eye in 20% (8) of the patients. In patients who preoperatively had DVD in their fellow eyes, 50% developed DVD postoperatively in their fellow eyes. In patients who preoperatively did not have DVD in their fellow eyes, 14.7% developed DVD postoperatively in their fellow eyes. Furthermore, the angle of the DVD in the fellow eye increased with the surgical dosage.

Unilateral SR recession is effective in patients with asymmetrical DVD. However, a high incidence rate of DVD in the fellow eye should be considered, especially when preoperatively there is a small DVD in the fellow eye or a large DVD angle in the operated eye, whenever monocular superior rectus recession surgery is performed.