Article
Surgical options in Duane's retraction syndrome
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Authors
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J. Fricke
- Zentrum für Augenheilkunde der Universität zu Köln, Abteilung Schielbehandlung und Neuroophthalmologie
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A. Neugebauer
- Zentrum für Augenheilkunde der Universität zu Köln, Abteilung Schielbehandlung und Neuroophthalmologie
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W. Rüßmann
- Zentrum für Augenheilkunde der Universität zu Köln, Abteilung Schielbehandlung und Neuroophthalmologie
| Published: | September 22, 2004 |
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Outline
Text
Objective
Most cases of connatal ocular misinnervation are caused by Duane´s retraction syndrome. Hypo- or aplasia of the sixth nerve combined of miswiring of third nerve fibers to lateral rectus cause clinically typical images with limitation of horizontal eye movements globe retraction and narrowing of the palpebral fissure. A causative therapy does not exist. Eye muscle surgery is indicated in cases with manifest strabismus in primary position and an annoying compensatory head posture to maintain binocular singel vision. Different surgical approaches to different types of Duane's retraction syndrome are described in the literature: Recession of one horizontal rectus muscle, recession - maybe asymmetric - of two antagonistic horizontal recti in cases of severe retraction, combined surgery with recessing and resecting procedures, transposition of vertical muscles and surgery on the fellow eye have been described.
Methods
We retrospectively analyzed the pre- and postoperative findings of all patients who underwent surgery in our clinic because of Duane's retraction syndrome during the years 1999-2004. Type of retraction syndrome, angle reduction in primary position and reduction of head posture were evaluated in regard to the surgical procedure chosen.
Results
42 patients aged between 2 and 68 years had received surgery. In 27 cases by a single recession of the medial rectus (15 and 3 revisions) or lateral rectus (7 and 2 revisions) the surgical aim was attained. In 9 cases combined surgery with additional tuck of the lateral rectus (6 and 2 revisions) or the medial rectus (1) was performed. In 4 cases solely the lateral rectus (2) was tightened by a tuck or the medial rectus (2 revisions) was advanced. In 2 cases an asymmetrical recession of both horizontal recti was chosen. We discuss the effect of the different procedures on the squint angle an the head posture.
Conclusions
Depending on the type of retraction syndrome, angle in primary position, head posture and globe retraction different surgical options exist to aim at rehabilitation of the patient with Duane´s retraction syndrome.
