Management of Duane retraction syndrome: A simplified approach

Abstract

Duane retraction (or co-contraction) syndrome is a congenital restrictive strabismus which can occur either as an isolated entity or in conjunction with other congenital anomalies and is now listed as a congenital cranial dysinnervation disorder. It is characterized by co-contraction of horizontal recti on attempted adduction causing globe retraction along with variable amounts of upshoots or downshoots. It may have limited abduction or adduction or both and present as esotropic, exotropic, or orthotropic Duane. The diagnosis of this disease is usually clinical. However, recent research has provided a greater insight into the genetic basis of this disease paving a way for a greater role of genetics in the diagnosis and management. This disease can have a varied presentation and hence the treatment plan should be tailor-made for every patient. The indications for surgery are abnormal head posture, deviations in the primary position, retraction and narrowing of palpebral aperture and up- or downshoots during adduction, and sometimes also to improve abduction. The arrival of newer surgical techniques of periosteal fixation (PF) of lateral rectus (LR), partial vertical rectus transposition, or superior or inferior rectus transposition in addition to LR recession with Y-split has vastly improved the management outcomes, providing not only primary position orthophoria but also increased binocular visual fields as well.

Advances in the Genetics of Congenital Ptosis

“…Ptosis occurs in association with other malformations such as Malpuech Michels Mingarelli Carnevale syndrome [57], Turner syndrome [58], Noonan syndrome [59], Baraitser-Winter cerebrofrontofacial syndrome [60], Kabuki syndrome [61], Kaufman oculocerebrofacial syndrome [62], Duane retraction syndrome [63,64], Ohdo syndrome [65], and so on. Mutations in the RYR1 [66] and ECEL1 [67] genes can also cause SCP.…”

Clinical features, management, and outcomes of expulsive choroidal hemorrhage during cataract surgery: 13-year experience of a tertiary eye center

“…Suprachoroidal hemorrhage (SCH) is the accumulation of blood within the potential space between the choroid and sclera, resulting from possible rupture of small arteries in this space. [1][2][3][4][5] An ECH is defined as sudden hemorrhagic swelling of the choroid, which develops during intraocular surgery, which is associated with the expulsion of some or all of the intraocular contents. 3 ECH is postulated to be due to acute hypotony or large fluctuation of intraocular pressure (IOP) with possible rupture of small arteries crossing the suprachoroidal space.…”

“…[1][2][3][4][5] An ECH is defined as sudden hemorrhagic swelling of the choroid, which develops during intraocular surgery, which is associated with the expulsion of some or all of the intraocular contents. 3 ECH is postulated to be due to acute hypotony or large fluctuation of intraocular pressure (IOP) with possible rupture of small arteries crossing the suprachoroidal space. 4,5 Several systemic and ocular risk factors have been described ECH.…”

“…[5][6][7][8][9] The overall incidence of intraoperative ECH has been described to range from 0.05% to 0.40%, with most series reporting an incidence of 0.20%. 1,3,5,7 The reported incidence of ECH during cataract surgery, glaucoma filtration surgery, and pars plana vitrectomy are 0.03% to 0.13%, 0.15%, and 0.4% to 0.6%, respectively. 5 Surgeons must identify the warning signs of ECH intraoperatively to manage them efficiently and is equally important to anticipate an ECH in susceptible patients.…”

“…5–9 The overall incidence of intraoperative ECH has been described to range from 0.05% to 0.40%, with most series reporting an incidence of 0.20%. 1,3,5,7 The reported incidence of ECH during cataract surgery, glaucoma filtration surgery, and pars plana vitrectomy are 0.03% to 0.13%, 0.15%, and 0.4% to 0.6%, respectively. 5…”