Surgical outcome of superior rectus transposition in esotropic Duane syndrome and abducens nerve palsy

Abstract

To evaluate surgical outcome of superior rectus transposition (SRT) in esotropic Duane syndrome (DS) and abducens nerve palsy. Retrospective medical record analysis of all patients with esotropic DS and abducens nerve palsy treated with SRT at our center with minimum follow-up of 6months. Primary outcome measures were esotropia in primary position and abduction limitation. Secondary outcome measures included head turn, stereopsis, and cyclovertical deviations. A total of 20 eyes of 19 patients were included: 9 with DS and 10 with traumatic abducens nerve palsy. One patient had bilateral esotropic DS. Mean age of DS patients was 12.5±10.1years; of abducens nerve palsy patients, 25.4±11.3years. Medial rectus recession (MRc) of 3.5mm was additionally performed in 5 DS eyes. An adjustable MRc 5.6±2.2mm with or without augmentation suture was performed in all abducens nerve palsy patients. In DS patients, esotropia improved from 27.5Δ ± 5.4Δ to 3.6Δ ± 6.4Δ (P<0.001), abduction limitation reduced from -3.8 to -1.8 (P<0.001), and head posture improved from 20° to 4° (P<0.001) at 6months. In abducens nerve palsy patients, esotropia improved from 51.5Δ ± 18.8Δ to 6.1Δ ± 10.7Δ (P<0.001), abduction limitation reduced from -3.8 to -2, and head posture improved from 25° to 8° (P<0.001). Stereopsis improved in 4 patients (P=0.12). No patient had vertical deviation or torsional diplopia. In our patient cohort with esotropic DS or abducens nerve palsy, SRT reduced esotropia and improved abduction. Because of a long-term exotropic drift, initial undercorrection in the immediate postoperative period may prevent eventual overcorrection.