MANAGEMENT OF DUANE RETRACTION SYNDROME

Abstract

Purpose: To determine the clinical profile of various subtypes of Duane retraction syndromepatients and to evaluate different surgical strategies in correction of different clinical signs.Patients and Methods: This was a hospital-based prospective interventional study conductedat the Ophthalmology department, Al-Azhar university hospital in Assiut over a duration of twoyears from October 2017 to October 2019. Thirty one patients of DRS were scheduled to beincluded in this study. They were divided into three groups; Group I: 21 patients of DRS type I,Group II: 4 patients of DRS type II and Group III: 6 patients of DRS type III. Age of patientsranged from 9 months to 28 yrs old. Postoperative results were evaluated over 6th monthsfollow-up period. Results: Thirteen patients were left without surgical intervention, they wereorthophoric or with minimal misalignment in PP with mild retraction of the globe on attemptedadduction and none of them had any vertical shoot nor abnormal head position, eighteen patients ofDRS had surgical intervention. Nine cases were exotropic, 8 cases were esotropic & 1 case wasorthophoric. Horizontal deviations were managed with unilateral or bilateral muscle recession&simultaneous recession of MR & LR. Retraction of the globe was managed with single musclerecession or simultaneous recession of both MR & LR. Vertical shoots were managed with LRY-splitting, IO recession& simultaneous recession of both MR& LR. Conclusion: Every patientof Duane retraction syndrome has an individual story, with good diagnosis & accurate grading todifferent signs we can determine the best surgical technique for the correctable signs. Singlemuscle recession & simultaneous recession of both MR & LR can correct horizontal strabismusin PP, the retraction of the globe on attempted adduction & the abnormal head position effectively.Overshoots can be corrected by LR Y-splitting, simultaneous recession of both MR& LR IOanteriorisation surgery is the best choice in cases with HT in PP & slow upshoot. Small LR resectioncan be done in esotropic cases with mild retraction (grade 1).