The results of surgical treatment in Duane's retraction syndrome

Abstract

In an attempt to evaluate the response to surgical treatment, the surgical outcome of 16 patients with Duane's retraction syndrome (DRS) was investigated. Single horizontal rectus muscle recession, transposition of vertical recti and recession of both horizontal recti were carried out. In one of the four patients with significant globe retraction, Y splitting of the lateral rectus muscle was added to the procedure to overcome the cosmetically unacceptable upshoot. Single horizontal muscle recession surgery was effective in reducing the abnormal head posture and the deviation in primary position. The results of both horizontal recti recession were not so predictable in reducing globe retraction. Recession of both horizontal recti was ineffective in vertical DRS. It is suggested that the variability of surgical outcome in DRS may be related to the different innervational patterns and mechanical factors.

Pearls and pitfalls in the management of Duane syndrome

“…Our results demonstrated that recession of both horizontal recti may decrease the globe retraction in 75% of the cases and up/downshoots as well as the deviation in primary position and abnormal head posture [Figure 3]. [41] In our series, we concluded that transposition surgery should be kept for those with minimal globe retraction. [41]…”

“…[3738394041] In our clinical practice, this is the most commonly used procedure in DS [Figure 2a and b]. Our results demonstrated that recession of both horizontal recti may decrease the globe retraction in 75% of the cases and up/downshoots as well as the deviation in primary position and abnormal head posture [Figure 3].…”

“…[41] In our series, we concluded that transposition surgery should be kept for those with minimal globe retraction. [41]…”

“…[373839404151525354556061] “Y” splitting of LR increases the stability of the LR muscle on adduction. Splitting the LR muscle creates some resection effect and should better be combined with a small recession to compensate this.…”

“…[ 9 10 11 ] In an early brainstem magnetic resonance imaging (MRI) study, we could only demonstrate the abducens nerve on the normal side of two out of ten patients. [ 12 ] However, with new-generation MRI equipment, more reliable data could be obtained in various types of DS. Kim and Hwang[ 13 ] demonstrated that the abducens nerve was absent in all cases with Type 1 DS, it was present in all Type 2 patients, and it was either absent or present in Type 3 DS.…”