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Abstract
Purpose
To present the results of patients undergoing surgical treatment and determine clinical guidelines for the face turn, and up and down shoot in Duane retraction syndrome (DRS).
Methods
Thirty-four patients with DRS were treated with single horizontal rectus muscle recession, lateral rectus (LR) recession with Y-splitting, or LR recession with Y-splitting combined with medial rectus (MR) recession. The different treatment approaches were based on the angle of deviation in the primary position, versions, and ductions. In all patients, ocular alignment, face turn and up and down shoot were assessed preoperatively and postoperatively.
Results
The average standard deviation reduced from 18.5 ± 6.5 prism diopters (PD) to 4.6 ± 5.8 PD in horizontal rectus muscle recession and 14.4 ± 5.5 PD to 1.6 ± 2.8 PD in LR recession with Y-splitting. LR recession with Y-splitting com-bined with MR recession was effective in reducing globe retraction. Postoperative 4-mm LR recession with Y-splitting did not change ocular alignment; 7-mm LR recession with Y-splitting showed an average correction of 12.8 PD. Postoperatively, all patients presented a reduction in face turn; however, there was no statistically significant difference between the 2 pro-cedures (Mann-Whitney U test, p = 0.620).
Conclusions
Decisions regarding surgical approaches in DRS should be based on the amount of deviation in primary eye position, the expression of up and down shoot, and the degree of face turn. Surgeons planning Y-splitting of LR with MR re-cession must consider modifying the MR recession amount due to the smaller LR recession effect of Y-splitting compared with conventional LR recession.
References
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Figure 1.
Postoperative change in face turn. LR = lateral rec-tus; MR = medial rectus; rec = recession. Graph shows a re-duction in face turn between two procedures. There is no stat-istically significant difference within the two procedures (Mann-Whitney U test, p = 0.620).
Table 1.
Patient characteristics of Duane’s retraction syndrom
| Baseline characteristics | No |
|---|---|
| Patients | 34 |
| Sex (male : female) | 21 : 13 |
| Laterality (OD*: OS†) | 9 : 25 |
| Age at diagnosis (year) | 7.0 ± 9.0 (0-41 |
| Age at operation (year) | 9.0 ± 8.6 (3-41 |
| Type Ⅰ: Ⅱ: Ⅲ‡ | 26 : 4 : 4 |
| Esotropia : Exotropia : Orthotropia | 17 : 14 : 3 |
| Horizontal rectus muscle rec : LR rec & | 15 : 16 : 3 |
| Y-splitting : LR rec & Y-splitting with MR rec | |
Table 2.
Ocular deviation for each type of Duane’s retraction syndrome
| Type | Esotropia | Exotropia | Orthotropia | Total |
|---|---|---|---|---|
| Ⅰ | 16 (61.5%) | 8 (30.8%) | 2 (7.7%) | 26 |
| Ⅱ | 0 (0%) | 3 (100%) | 0 (0%) | 3 |
| Ⅲ | 1 (20.0%) | 3 (60.0%) | 1 (20.0%) | 5 |
| Total | 17 | 14 | 3 | 34 |
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