Rates of Reoperation in Duane Retraction Syndrome

Abstract

PurposeTo investigate the types of strabismus surgeries performed and the reoperation rate in patients with Duane Retraction Syndrome (DRS). DesignRetrospective cohort analysis MethodsAn insurance claims dataset was used to identify patients diagnosed with DRS between 2007 and 2021. We recorded the type of strabismus surgery performed and the timing and frequency of reoperations. The hazard ratios (HR) for reoperation were estimated according to the surgical methods using Cox regression analysis. ResultsOf the 9435 patients diagnosed with DRS, 1023 (10.8%) underwent at least one strabismus operation. The median age at surgery was 5.0 years, and patients were followed for an average of 3.8 ± 3.0 years after their initial strabismus surgery. Most of the surgeries only involved horizontal muscle(s) (n = 734 [71.7%]). However, some patients underwent surgeries on vertical muscle(s) (n = 132 [12.9%]), vertical muscle(s) with transposition (n = 102 [10.0%]), and horizontal muscle with transposition (n = 51 [5.0%]). The estimated 5-year rate of reoperation was 18.2% (95% CI 15.0% - 22.2%). Compared to surgery on horizontal muscle(s) only, vertical muscle surgery (HR, 2.01; 95% confidence interval, 1.30-3.11; p = 0.002) and vertical muscle surgery coupled with transposition (HR, 1.79; 95% confidence interval, 1.06-3.02; p = 0.03) had an increased risk of reoperation. ConclusionStrabismus surgery on one or more horizontal muscles is the most common type of strabismus surgery performed on patients with DRS. Approximately 1 in 7 patients with DRS who had strabismus surgery underwent a reoperation. Patients who underwent vertical muscle surgery had a higher risk of undergoing a reoperation.