Reoperation in esotropic Duane retraction syndrome: Long-term motor outcome of superior rectus transposition

2019 ◽  
pp. 112067211989788
Author(s):  
Adriano Magli ◽  
Luca Rombetto ◽  
Paolo Esposito Veneruso
Keyword(s):  
Head Position ◽  
Medial Rectus ◽  
Head Turn ◽  
Superior Rectus ◽  
Vertical Deviation ◽  
Retraction Syndrome ◽  
Motor Outcome ◽  
Duane Retraction Syndrome

Aim: The aim was to evaluate the long-term motor outcome of superior rectus transposition procedure in patients affected by unilateral esotropic Duane retraction syndrome with residual esotropia and anomalous head position. Methods: A retrospective analysis of medical records of patients affected by esotropic Duane retraction syndrome who underwent superior rectus transposition procedure as reoperation for residual esotropia and/or residual anomalous head position. Amount of deviation, anomalous head position, duction limitation, globe retraction, presence of upshoot/downshoot, and vertical deviation were analyzed before and after superior rectus transposition procedure. Results: Twenty patients were selected. All patients underwent unilateral medial rectus recession or bilateral medial rectus recession, for unilateral esotropic Duane retraction syndrome at least 2 years before superior rectus transposition reoperation. Mean age at surgery (superior rectus transposition) was 12 ± 6.8 years, and the follow-up period was 2.7 ± 0.6. Mean deviations at distance and near before surgery were 19.5 ± 5.7 and 15.2 ± 6.8, respectively. Two patients showed upshoot. Head turn was 11.4 ± 5.1°; abduction limitation was −2.6 ± 0.9. After superior rectus transposition, all patients showed an improvement of esotropia at distance and near (8.1 ± 5.7 and 5.1 ± 5.6, respectively; p < 0.05), anomalous head position (5.6 ± 3.9°; p < 0.05), and abduction limitation (−2.3 ± 0.8; p < 0.05). No statistically significant changes occurred in globe retraction. No adduction limitation, vertical deviation, and upshoot/downshoot were present after superior rectus transposition procedure. Results were stable during follow-up. Conclusion: Superior rectus transposition procedure is an effective procedure in esotropic Duane retraction syndrome patients who previously undergone unilateral/bilateral medial rectus recession, with residual esotropia and anomalous head position. It allows improvement of esotropia, head turn, and partial recovery of abduction in a significant percentage of patients (30%) with no vertical complications.

scholarly journals Results of asymmetric bilateral medial rectus retroposition in unilateral Duane retraction syndrome’s type I

2012 ◽  
Vol 59 (3) ◽  
pp. 77-80
Author(s):  
Milorad Ljutica ◽  
Miroslav Stamenkovic ◽  
Dusica Risovic ◽  
Nebojsa Nikitovic ◽  
Branko Stankov
Keyword(s):  
Anterior Segment ◽  
Medial Rectus ◽  
Type I ◽  
Refractive Errors ◽  
Pathological Changes ◽  
Retraction Syndrome ◽  
Before And After ◽  
Duane Retraction Syndrome ◽  
The Right

Objective: To describe the results of asymmetric bilateral medial rectus retroposition in unilateral Duane retraction syndrome-this type I. Method: This is a retrospective study involving 18 patients, mean age 11.2 years (3-37 years) with unilateral Duane retraction syndrome?s type who were operated in 2009 up to 2011 year. The aim was to investigate the existence of ocular torticollis, size deviation before and after surgery and presence of amblyopia, anisometropia, type of refractive errors and lateralization. Results: All 18 patients were surgically treated by asymmetric retroposition of internal rectus (for 1-2mm more on the healthy eye). All patients preoperatively de-monstrated ocular torticollis. Size of mean preoperative deviation was +22.2 pD of primary angle PD and +46 pD of secondary angle. Postoperative finding: deviation of> +10 PD is noted to the presence of mild torticollis in one patient. Intermediate follow-up period was 9.8 months. Unilateral Duane?s syndrome is common among members of women (67%) compared to males (33%). Lateralization of Duane?s syndrome is more common in the left eye compared to the right (83% vs. 17%). Amblyopia was present in two patients and anisometropia (11.1%). As for refractive errors: hyperopia was found in 9 patients (50%), hypermetric astigmatism in 7 cases (39%), myopia and 1 (5.5%) and emmetropia (5.5%). None of the patients had no pathological changes in the fundus and anterior segment. Conclusion: Asymmetric bilateral medial rectus retroposition is extremely effective in the treatment of ocular torticollis and esotropia in patients with unilateral Duane retraction syndrome-this type I.

Modified Y Splitting of Lateral Rectus in Treatment of Abnormal Vertical Eye Movements Combined with Globe Retraction in Duane Retraction Syndrome

2020 ◽  
pp. 1-3
Author(s):  
Ayse Gul Kocak Altintas ◽  
Ayse Gul Kocak Altintas
Keyword(s):  
Case Report ◽  
Eye Movements ◽  
Palpebral Fissure ◽  
Ocular Motility ◽  
Severe Restriction ◽  
Horizontal Movement ◽  
Retraction Syndrome ◽  
Duane Retraction Syndrome ◽  
Ocular Motility Disorders

Duane retraction syndrome is the most frequently seen restrictive ocular motility disorders. It is clinically presented with limitation of horizontal movement, variable amounts of upshoots or downshoots and globe retraction combined with narrowing of the palpebral aperture on attempted adduction. An 8-year-old patient presented with severe restriction of abduction, reciprocal upshots or downshoots, and globe retraction combined with the palpebral fissure narrowing of on adduction. After the modified Y splitting of LR and recession of both horizontal rectus operation, all cosmetically disfiguring clinical features disappeared. In this case report modified Y splitting procedure and its long-term efficacy is presented.

Long-term outcomes following resection-recession versus plication-recession in children with intermittent exotropia

2019 ◽  
Vol 104 (3) ◽  
pp. 350-356 ◽  
Author(s):  
Haeng-Jin Lee ◽  
Seong-Joon Kim
Keyword(s):  
Surgical Outcomes ◽  
Lateral Rectus ◽  
Medial Rectus ◽  
Clinical Factors ◽  
Long Term Outcomes ◽  
Intermittent Exotropia ◽  
Surgical Success ◽  
Angle Of Deviation

Background/AimsTo compare the long-term surgical outcomes between unilateral lateral rectus recession-medial rectus resection (RR) and lateral rectus recession-medial rectus plication (RP) in children with intermittent exotropia.MethodsChildren who underwent RR or RP for intermittent exotropia between January 2008 and July 2016, with a minimum follow-up period of 2 years were retrospectively reviewed. Postoperative angle of deviations and clinical factors including sex, age, refractive errors, preoperative angle of deviation, types of exotropia and stereopsis were investigated. Based on the angle of deviation at year 2, surgical outcomes were classified into two groups as follows: success (esodeviation ≤5 prism dioptres (PD) to exodeviation ≤10 PD) and failure (overcorrection (esodeviation >5 PD) and undercorrection or recurrence (exodeviation >10 PD)).ResultsOf the 186 patients, 114 underwent RR and 72 underwent RP. The angle of exodeviation steadily increased over time in both groups after surgery. The durations of exodrift were longer in the RP group than in the RR group. The surgical success at postoperative year 2 was 55.3% in the RR group and 27.8% in the RP group (p<0.001). The amount of overcorrection was associated with successful outcomes in both groups.ConclusionsIn children with intermittent exotropia, RR group presented better surgical outcomes than RP group. The amount of initial overcorrection was important to achieve favourable outcomes in children with intermittent exotropia.

Modified Y- split and recession of medial rectus muscles in convergence excess esotropia

2020 ◽  
pp. 112067212096549
Author(s):  
Abbas Bagheri ◽  
Ehsan Abbasnia ◽  
Mehdi Tavakoli
Keyword(s):  
Rectus Muscle ◽  
Medial Rectus ◽  
Final Visit ◽  
Modified Technique ◽  
Long Term Follow Up ◽  
The Mean ◽  
Residual Distance ◽  
Convergence Excess

Purpose: The convergence excess esotropia (CEET) is defined when near esotropia is greater than the distance by at least 10 PD while the eye is corrected with the full cycloplegic refraction. The purpose of this study is to evaluate the effect of a modified technique of Y- split recession of the medial rectus muscles on CEET. Methods: This was a retrospective study on patients diagnosed with CEET. The surgery included longitudinally dividing the medial rectus muscles into two equal halves and re-attaching them in a recessed and one-tendon width apart position. Success was defined as a residual distance and near esotropia of less than 10 PD and a distance-near disparity of less than 5 PD. Results: Fourteen patients, including 8 (57.1%) females, were enrolled with a mean age of 7.1 ± 2.9 years. The mean follow-up period was 28.6 ± 12.1 months. The mean preoperative distance and near esotropia was 31 ± 10 and 45 ± 11.3 PD respectively that decreased to 2.4 ± 3 and 3.6 ± 3.8 PD at the final visit ( p < 0.001). The Mean distance-near disparity of esotropia was 14 ± 4.5 PD before the operation that decreased to 1.3 ± 1.8 PD at the final visit ( p < 0.001). The motor success rate was 78.6%, bifocal glasses were no more required in 92.9% of patients, and stereopsis improved in 35.7% of patients after the surgery. Conclusion: Bilateral modified Y- split and recession of the medial rectus muscle is an effective technique for the treatment of CEET with persistent outcomes in the long-term follow-up.

scholarly journals Y-Split Recession of the Medial Rectus Muscle as a Secondary and/or Unilateral Procedure in the Treatment of Esotropia with Distance/Near Disparity

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Monika Wipf ◽  
Siegfried Priglinger ◽  
Anja Palmowski-Wolfe
Keyword(s):  
Side Effects ◽  
Treatment Option ◽  
Rectus Muscle ◽  
Medial Rectus ◽  
Long Term Results ◽  
Posterior Fixation ◽  
Secondary Surgery ◽  
Lateral Rectus Muscle

Introduction. In esotropia with larger angles > near than at distance, splitting of the medial rectus muscle has been suggested as a treatment option. Previous reports of bilateral medial rectus Y-splitting as a first intervention showed a reduction of the distance/near disparity with fewer side effects compared to posterior fixation surgery. We address whether a medial rectus Y-splitting as a secondary and/or a unilateral procedure also reduce distance/near disparity.Materials and Methods. We retrospectively reviewed the charts of four patients undergoing Y-split recession as a second and/or unilateral surgery. Main outcomes were distance/near disparity and squint angles.Results and Discussion.Three of the four patients had undergone unilateral Y-splitting of the medial rectus as a secondary surgery, three as a unilateral procedure. Mean distance/near disparity was reduced from 17 PD preoperatively to zero at the final follow-up (FU). Preoperative angles ranged from 45 PD to 66 PD at near and from 25 PD to 55 PD at distance. At the final FU, these angles ranged from 0 PD to 20 PD at near and at distance. Mean FU was 42 months (range: 12–60 months).Conclusion. Y-split recession as a secondary and/or unilateral surgery for distance/near esotropia can reduce distance/near disparity with good long-term results. Residual esotropia can be corrected by adding resection of the lateral rectus muscle.

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