Isolated Y-Splitting and Recession of the Lateral Rectus Muscle in Patients with Exo-Duane Syndrome

Abstract

Purpose Weakening of both horizontal rectus muscles is performed for patients with Duane syndrome and significant misinnervation of the lateral rectus (LR) muscle resulting in strabismus, limitation to ocular rotations, and globe retraction. In patients with severe up-/downshoots, a Y-splitting of the LR is often recommended. The purpose of this study was to evaluate the efficacy of isolated unilateral LR recession-Y splitting in exo-Duane patients with limitation to adduction and up-/downshoots. Methods Retrospective review of the records of consecutive patients with exo-Duane syndrome and up/downshoots who underwent isolated Y-splitting-recession of the affected LR. Results The records of 10 patients were reviewed (mean age at surgery 23 ± 21 years). The Y-split was performed 10 mm posterior to the insertion and was combined with a mean LR recession of 8.7 ± 2.9 mm. Torticollis decreased from 12.7 ± 4.4° to 4.8 ± 5.3° (P = 0.003). Exotropia improved from 18.4 ± 7.3 to 6.2 ± 5.9 PD postoperatively (P < 0.001). Exotropia in contralateral gaze improved from 33.7 ± 11.8 to 18.7 ± 18.1 PD postoperatively (P = 0.09). No significant postoperative changes in esotropia in ipsilateral gaze, vertical deviations, or ocular rotations in adduction or abduction were observed. Downshoots were significantly decreased (P = 0.01), and there was a trend toward improvement of upshoots (P = 0.07). There were no overcorrections, although 3 patients required additional LR weakening and transposition. Conclusions LR Y-splitting–recession improves ocular alignment, torticollis, and up-/downshoots. LR recession improves ocular alignment and torticollis, while the addition of a Y-split procedure improves up-/downshoots.

Duane syndrome: Clinical features and surgical management

“…These findings were consistent with reported rates in the literature. [4][5][6][7][8] However, 96% of patients had fissure-narrowing/globe retraction on adduction, which was higher than reported rates in the literature. [9][10][11][12][13] The majority of our patients were classified as Duane group I (56%) followed by group III (28%) and group II (16%).…”

“…[4][5][6][7][8]14,15 In our surgical subset of 18 patients (14 type I and 4 type II), the majority had an excellent surgical outcome with significant improvements in AHP and FPP alignment.…”

Modified Y-splitting Procedure for the Treatment of Duane Retraction Syndrome

“…Velez et al 13 performed isolated Y-splitting combined with a mean LR recession of 8.7 mm in 10 XT DRS patients with limitation of adduction and up or downshoot. They observed a significant decrease in downshoot and a trend towards improvement of upshoot, but 3 out of 10 patients required additional surgeries.…”

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

“…Three patients had ipsilateral lateral rectus recessions with unsatisfactory results and 8 patients had contralateral lateral rectus recession with ipsilateral Y-splitting of the lateral rectus muscle as needed, 7 of which had satisfactory surgical results. Velez et al 6 described the largest series of unilateral rectus recession together with Y-splitting. In their series of 10 cases, 3 patients required a second procedure, 2 of whom had contralateral lateral rectus recession as a second procedure due to persistent exotropia.…”

“…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.…”