Management of Duane Retraction Syndrome

Abstract

Purpose: To determine the clinical profile of various subtypes of Duane retraction syndrome patients and to evaluate different surgical strategies in correction of different clinical signs. Patients and Methods: This was a hospital-based prospective interventional study conducted at the Ophthalmology department, Al-Azhar university hospital in Assiut over a duration of two years from October 2017 to October 2019. Thirty one patients of DRS were scheduled to be included in this study. They were divided into three groups; Group I: 21 patients of DRS type I, Group II: 4 patients of DRS type II and Group III: 6 patients of DRS type III. Age of patients ranged from 9 months to 28 yrs old. Postoperative results were evaluated over 6 th months follow-up period. Results: Thirteen patients were left without surgical intervention, they were orthophoric or with minimal misalignment in PP with mild retraction of the globe on attempted adduction and none of them had any vertical shoot nor abnormal head position, eighteen patients of DRS had surgical intervention. Nine cases were exotropic, 8 cases were esotropic & 1 case was orthophoric. Horizontal deviations were managed with unilateral or bilateral muscle recession& simultaneous recession of MR & LR. Retraction of the globe was managed with single muscle recession or simultaneous recession of both MR & LR. Vertical shoots were managed with LR Y-splitting, IO recession& simultaneous recession of both MR& LR. Conclusion: Every patient of Duane retraction syndrome has an individual story, with good diagnosis & accurate grading to different signs we can determine the best surgical technique for the correctable signs. Single muscle recession & simultaneous recession of both MR & LR can correct horizontal strabismus in PP, the retraction of the globe on attempted adduction & the abnormal head position effectively. Overshoots can be corrected by LR Y-splitting, simultaneous recession of both MR& LR IO anteriorisation surgery is the best choice in cases with HT in PP & slow upshoot. Small LR resection can be done in esotropic cases with mild retraction (grade 1).