Severe Adduction Deficiency Following a Large Medial Rectus Recession in Duane's Retraction Syndrome

Nelson, Leonard B

doi:10.1001/archopht.1986.01050180093038

Cited by 42 publications

(20 citation statements)

References 12 publications

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“…6,7 Bilateral MRc is used for larger angles. Recessions of the contralateral medial rectus muscle are sometimes used, but the approach remains controversial, 2,13-15 with a paradoxical increase in head turn described in some cases.…”

Section: Discussionmentioning

confidence: 99%

Superior Rectus Transposition vs Medial Rectus Recession for Treatment of Esotropic Duane Syndrome

et al. 2014

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Superior rectus transposition (SRT) with or without medial rectus recession (MRc) has been introduced as an alternative to MRc alone for treatment of esotropic Duane syndrome; however, the effectiveness of these procedures has not been compared previously.OBJECTIVE To compare the safety and efficacy of MRc and SRT in treatment of Duane syndrome. DESIGN, SETTING, AND PARTICIPANTSRetrospective medical record review of all patients with esotropic Duane syndrome who underwent surgical treatment from January 1, 2006, through December 31, 2012, in a multispecialty, hospital-based pediatric ophthalmology/adult strabismus practice at Boston Children's Hospital. Patients in the SRT group underwent SRT with or without MRc; those in the non-SRT group underwent unilateral or bilateral MRc.EXPOSURES Surgical treatment of esotropic Duane syndrome.MAIN OUTCOMES AND MEASURES Binocular alignment, ocular ductions, head position, stereopsis, and fundus torsion were recorded before surgery and at the 2-month and final postoperative visits. We also evaluated postoperative drift. RESULTSThe medical record review identified 36 patients who underwent 37 procedures, including 19 in the SRT group (13 SRT + MRc and 6 SRT alone) and 18 in the non-SRT group (11 unilateral MRc and 7 bilateral medial rectus resession). Mean MRc was smaller when performed with SRT (3.3 vs 5.3 mm; P = .004). Although the initial deviation was larger in the SRT group, both groups had a similar improvement in esotropia and head turn. Abduction improved by at least 1 unit in 15 of 19 patients in the SRT group (79%) vs 5 of 18 in the non-SRT group (28%). In 24 patients followed up for more than 6 months, mean esotropia decreased from 8.2 to 6.1 prism diopters (Δ) in the SRT group (n = 12) but increased from 7.2 to 10.9Δ in the non-SRT group (n = 12). CONCLUSIONS AND RELEVANCEThe combination of SRT and MRc was more effective than MRc or bilateral medial rectus resession at improving abduction while allowing for a smaller recession to align the eyes and eliminate a compensatory head posture. Although any surgery on the vertical rectus muscles should in theory increase the risk for vertical or torsional complications, to date this theory has not been borne out in our patients. Patients treated with SRT appear to have a reduced likelihood of long-term undercorrection. We therefore recommend SRT with adjustable MRc for treatment of Duane syndrome in patients with larger amounts of esotropia.

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Section: Discussionmentioning

confidence: 99%

Superior Rectus Transposition vs Medial Rectus Recession for Treatment of Esotropic Duane Syndrome

et al. 2014

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“…Several surgical methods have been proposed in the ophthalmic literature to treat DRS, [23][24][25][26][27] but most apply to types 1 and 2. Published results of DRS type 3 surgery are sparse in the medical literature, and the approaches used were not uniform.…”

Section: Discussionmentioning

confidence: 99%

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

Snir

Dotan

Friling

et al. 2013

Eye

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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.

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“…[12][13][14] This increases the risk of consecutive exotropia, [13][14][15] limits convergence, and decreases the range of adduction, which in turn decreases the field of binocular single vision. The purpose of this study is to describe the outcomes of bilateral medial rectus muscle recessions in the treatment of bilateral esotropic Duane syndrome.…”

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confidence: 99%

Surgical management of bilateral esotropic Duane syndrome

Sachdeva

Kekunnaya

Gupta

et al. 2012

Journal of American Association for Pediatric Ophthalmology and

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Severe Adduction Deficiency Following a Large Medial Rectus Recession in Duane's Retraction Syndrome

Cited by 42 publications

References 12 publications

Superior Rectus Transposition vs Medial Rectus Recession for Treatment of Esotropic Duane Syndrome

Superior Rectus Transposition vs Medial Rectus Recession for Treatment of Esotropic Duane Syndrome

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

Surgical management of bilateral esotropic Duane syndrome

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