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

Magli, Adriano; Rombetto, Luca; Veneruso, Paolo Esposito

doi:10.1177/1120672119897889

Cited by 4 publications

(16 citation statements)

References 20 publications

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“…We performed SRT in only one patient with residual esotropia which led to successful outcome. In a recent study, Magli et al 19 reported that SRT is an effective surgery in patients with residual esotropia and AHP after unilateral or bilateral medial rectus recession.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of symmetric bilateral medial rectus recession in large-angle esotropic Duane syndrome

Nabie

Manouchehri

Azad

2020

European Journal of Ophthalmology

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Purpose: To evaluate the efficacy of symmetric bilateral medial rectus recession in large-angle esotropic Duane retraction syndrome (DRS) with moderate to severe globe retraction. Methods: In a retrospective study, medical reports of 30 patients with esotropia of equal or more than 20 prism diopters (pd) and moderate to serve globe retraction due to unilateral DRS who underwent symmetric bilateral medial rectus recession were reviewed. Age, gender, laterality, amblyopia, length of follow-up, pre- and postoperative measurements of primary position deviation, ocular ductions and severity of globe retraction and abnormal head posture were evaluated. A successful result was defined as decreasing esotropia to equal or less than 8 pd or equal or less than 8 pd of consecutive exotropia. Results: The mean age of patients at surgery was 13.7 ± 8.5 years old (range: 3–38). The mean preoperative esotropia measured 28.9 ± 9.1 pd in distance and 25.7 ± 7.2 pd in near, which decreased to 4.9 ± 6.1 pd in distance and 3.9 ± 8.8 pd in near postoperatively. The mean bilateral medial rectus recession was 4.9 ± 0.9 mm (range: 3–6 mm). The mean abnormal head posture improved from 19.1 ± 6.9 degrees (range: 10–30 degrees) to 3.3 ± 4.7 degrees (range: 0-15 degrees) postoperatively. At the last follow-up visit, 23 patients (76.7%) had a successful outcome. Conclusions: In the large-angle esotropic DRS patients with moderate to severe globe retraction, symmetric bilateral medial rectus recession, can be conducted to successfully resolve primary position deviation and abnormal head posture.

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Section: Discussionmentioning

confidence: 99%

Outcomes of symmetric bilateral medial rectus recession in large-angle esotropic Duane syndrome

Nabie

Manouchehri

Azad

2020

European Journal of Ophthalmology

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“… 20 As a re-operation for residual esodeviation or residual AHP, in cases with residual AHP despite previous horizontal muscle surgery. 21 To treat cases where abduction limitation is more severe in upgaze than in downgaze (A pattern of motility). 22 To improve alignment and enhance abduction following LR inactivation for severe co-contractions and overshoots in both esotropic as well as exotropic DRS.…”

Section: Pre-operative Considerations Indications and Contra-indications Of Srtmentioning

confidence: 99%

“…As a re-operation for residual esodeviation or residual AHP, in cases with residual AHP despite previous horizontal muscle surgery. 21 …”

Section: Pre-operative Considerations Indications and Contra-indications Of Srtmentioning

confidence: 99%

“… 32 Myopexy suture – In this technique, an augmentation suture (5–0 or 6–0 polyester) is passed 8–12 mm behind the lateral rectus insertion, incorporating one-fourth thickness of each of the superior and lateral rectus muscles and simply uniting the two muscles as a loop myopexy with no scleral pass. 8 Multiple augmentation sutures - Magli et al 21 also suggested that in cases with a more prominent face turn one may use two augmentation sutures, at 8 and 10 mm behind the LR insertion for better long term improvement after the SRT. Resection of the muscle before transposition - Another technique of augmentation includes resecting the SR before transposing it (Brooks modification).…”

Section: Surgical Techniques Of Srtmentioning

confidence: 99%

“…Multiple augmentation sutures - Magli et al 21 also suggested that in cases with a more prominent face turn one may use two augmentation sutures, at 8 and 10 mm behind the LR insertion for better long term improvement after the SRT.…”

Section: Surgical Techniques Of Srtmentioning

confidence: 99%

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Superior Rectus Transposition in the Management of Duane Retraction Syndrome: Current Insights

Negalur

Sachdeva

Kekunnaya

2022

OPTH

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Various surgical approaches have been described for the management of Duane retraction syndrome (DRS), a type of congenital cranial dysinnervation disorder (CCDD), the goals of which include correcting the primary position deviation and abnormal head posture (AHP), minimizing globe retraction and overshoots and improving the ocular rotations. Vertical rectus transposition (VRT) is one such technique, found more effective in improving abduction and thereby expanding the field of binocular vision, as compared to horizontal muscle surgery. VRT, however, is associated with the risk of inducing vertical deviations and also poses a risk for development of anterior segment ischemia. To overcome these concerns, transposition of only the superior rectus to the lateral rectus was proposed and evaluated to reveal improvement in alignment, AHP and motility comparable to VRT but with lesser surgical time and fewer post-operative complications. With promising results in the management of DRS, superior rectus transposition (SRT) has been extensively studied and has evolved over the last decade with several modifications to further increase the efficiency and reduce the risk of post-operative complications. This article focusses on the pre-operative considerations while planning SRT in DRS, various approaches and surgical techniques described, and the outcomes and complications of SRT in DRS. The role of SRT in the management of other CCDDs may be explored with further studies.

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Hummelsheim procedure combined with medial rectus recession in complete sixth nerve palsy and esotropic Duane Retraction Syndrome

Bagheri

Veisi

Tavakoli

2020

European Journal of Ophthalmology

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Purpose: To evaluate the effect of half tendon vertical rectus muscle transposition (HVRT) combined with medial rectus muscle recession (MRrec) in complete sixth nerve palsy (CSNP) and esotropic Duane Retraction Syndrome (eDRS). Methods: A retrospective study of patients with unilateral CSNP or eDRS who underwent HVRT combined with medial rectus recession over the course of 18 years. The patients with previous strabismus surgery and follow up less than 3 months were excluded. Overcorrection was defined as any amount of exotropia, and undercorrection was defined as residual esotropia of ⩾10 prism diopter (PD). Results: A total of 39 patients were enrolled including 22 CSNP and 17 eDRS patients. Esotropia improved from 45.8 ± 22 and 22.5 ± 6.4 PD to 0.8 ± 2.5 and 0.3 ± 1 PD in CSNP group and eDRS group respectively. The angle of face turn improved from 34.3 ± 8.4° and 26.5 ± 9° to 0.6 ± 2.4° and 0.8 ± 1.6° in the CSNP group and eDRS group respectively. Abduction limitation improved from −4.5 ± 0.5 and −4 ± 0 units to −2.9 ± 0.5 and −2.7 ± 0.5 units in CSNP group and eDRS group respectively. No patient developed a new vertical deviation. An overcorrection occurred in one patient of the eDRS group who improved after botulinum toxin injection in the ipsilateral lateral rectus muscle. Undercorrection was seen in two patients. Conclusion: HVRT combined with MRrec is an effective procedure to improve esotropia, face turn, and abduction limitation in CSNP and eDRS.

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

Cited by 4 publications

References 20 publications

Outcomes of symmetric bilateral medial rectus recession in large-angle esotropic Duane syndrome

Outcomes of symmetric bilateral medial rectus recession in large-angle esotropic Duane syndrome

Superior Rectus Transposition in the Management of Duane Retraction Syndrome: Current Insights

Hummelsheim procedure combined with medial rectus recession in complete sixth nerve palsy and esotropic Duane Retraction Syndrome

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