Contralateral lateral rectus muscle recession in patients with Duane retraction syndrome type 3

Abstract

Aims The aim of this study was to evaluate the motor, sensory, functional, and head posture results of recession of the lateral rectus muscle contralateral to the involved eye in patients with exotropic Duane retraction syndrome (DRS) type 3. Methods This was a retrospective, longitudinal, observational study of a consecutive clinical case series. Of the 11 patients with DRS type 3 operated on at a tertiary medical center from 1977 to 2012, 8 underwent recession of the lateral rectus muscle contralateral to the involved eye (with combined Y-splitting of ipsilateral lateral rectus muscle in 3 of them). Full ophthalmic, orthoptic, and neurological examination was performed before and after surgery. Main outcome measures included intragroup changes in motor misalignment, abnormal head turn, ocular upshoot, and stereopsis. Results Mean patient age was 8.75 ± 3.1 years at surgery. Mean exodeviation for distance was À 17.3±3.5 prism diopters (PD) preoperatively and À 4.0±6.1 PD postoperatively; corresponding values for near were À 23.1 ± 7.2 PD and À 5.9 ± 8.7 PD. Motor deviation improved by 77% for distance (P ¼ 0.017) and 74.5% for near (P ¼ 0.01). In 7/8 patients, the postoperative residual exodeviation (distance and near) was o8.0 PD. There was an 80% improvement in head turn, from 15.3±41 before surgery to 3.1 ± 5.01 after (P ¼ 0.01). Stereopsis improved significantly in 6/8 patients. Findings remained stable during follow-up (mean duration 35.9 ± 50.8 months, range 5-132 months). Conclusions Contralateral lateral rectus muscle recession appears to be a promising technique for the treatment of moderate unilateral DRS type 3, with patients showing significant motor and functional improvement and a decrease in head turn.

The Efficacy of Bilateral Lateral Rectus Recession According to Secondary Deviation Measurements in Unilateral Exotropic Duane Retraction Syndrome

“…The mean preoperative exotropia in primary position measured in our study was significantly higher than in both previous larger series by Snir et al 5 and Velez et al 6 (27.9 ± 5.7 PD with the first case included and 25.8 ± 1.9 PD without the first case included compared to 17.3 ± 3.5 PD and 18.4 ± 7.3 PD, respectively; P < .05). We do not know whether this difference is incidental or can be attributed to the different measurement techniques used.…”

“…Snir et al 5 recently presented the surgical results of 11 cases of exotropic Duane retraction syndrome.…”

“…By dividing the recession between the two lateral rectus muscles rather than only one, whether it was either the affected muscle as described by Velez et al 6 or the unaffected muscle as described by Snir et al, 5 we avoided increased abduction deficit.…”

“…According to the ophthalmic literature, the most common surgical approach in cases of exotropic Duane retraction syndrome is unilateral lateral rectus recession (of either the affected eye or, less commonly, the contralateral eye). [4][5][6][7] The purpose of this study was to report for the first time a series of patients undergoing a bilateral lateral rectus recession procedure for unilateral exotropic Duane retraction syndrome with abnormal head turn posture according to the secondary deviation, as measured by the alternate cover test in forced primary position.…”

Y-Split Recession vs Isolated Recession of the Lateral Rectus Muscle in the Treatment of Vertical Shooting in Exotropic Duane Retraction Syndrome

“…In 2013, Sukhija and Kaur (28) reported significant improvement in horizontal deviation and face turn with significant reduction in the upshoot and almost elimination of downshoot in all patients after Y-splitting associated with 10 to 14 mm recession of the LR muscle in 7 patients with XT-DRS associated with vertical shooing on adduction. In 2014, Snir and colleagues (29) studied the effect of contralateral LR recession in the noninvolved eye for treatment of XT-DRS. In 3 out of 11 patients, that was combined with ipsilateral 1 mm Y-split recession of the LR in the involved eye to ­address ­associated moderate to severe upshoot on adduction, which resulted in elimination of the upshoot postoperatively.…”