Isolated Y-splitting and recession of the lateral rectus muscle in patients with exo-Duane syndrome

Abstract

Purpose-Weakening of both horizontal rectus muscles is performed for patients with Duane syndrome and significant misinnervation of the lateral rectus (LR) muscle resulting in strabismus, limitation to ocular rotations, and globe retraction. In patients with severe up-/downshoots, a Ysplitting of the LR is often recommended. The purpose of this study was to evaluate the efficacy of isolated unilateral LR recession-Y splitting in exo-Duane patients with limitation to adduction and up-/downshoots. Methods-Retrospective review of the records of consecutive patients with exo-Duane syndrome and up/downshoots who underwent isolated Y-splitting-recession of the affected LR.Results-The records of 10 patients were reviewed (mean age at surgery 23 ± 21 years). The Ysplit was performed 10 mm posterior to the insertion and was combined with a mean LR recession of 8.7 ± 2.9 mm. Torticollis decreased from 12.7 ± 4.4° to 4.8 ± 5.3° (P = 0.003). Exotropia improved from 18.4 ± 7.3 to 6.2 ± 5.9 PD postoperatively (P < 0.001). Exotropia in contralateral gaze improved from 33.7 ± 11.8 to 18.7 ± 18.1 PD postoperatively (P = 0.09). No significant postoperative changes in esotropia in ipsilateral gaze, vertical deviations, or ocular rotations in adduction or abduction were observed. Downshoots were significantly decreased (P = 0.01), and there was a trend toward improvement of upshoots (P = 0.07). There were no overcorrections, although 3 patients required additional LR weakening and transposition.Conclusions-LR Y-splitting-recession improves ocular alignment, torticollis, and up-/ downshoots. LR recession improves ocular alignment and torticollis, while the addition of a Ysplit procedure improves up-/downshoots.