Vertical rectus recession for the innervational upshoot and downshoot in Duane's retraction syndrome.

Abstract

To report the results of recession of the vertical rectus muscle for the innervational upshoot and downshoot in Duane's retraction syndrome. Ten patients who had Duane's retraction syndrome with innervational upshoot or downshoot underwent recession of the superior and inferior rectus muscle for the upshoot and downshoot, respectively. This procedure was combined with recession of the lateral rectus muscle(s) for exotropia in 6 patients and for the mechanical upshoot-downshoot in one patient. Postoperatively, the effects of surgery on the upshoot/downshoot, and horizontal and vertical deviation in the primary position were recorded. Average follow-up period was 1.2 years. Following surgery, the innervational upshoot/downshoot was eliminated in all patients. Mean vertical deviation in the primal position in 6 patients was reduced from 21.2 to 2.5 prism diopters and none of them developed a consecutive vertical imbalance. Four patients did not have a vertical deviation in the primary position preoperatively and one of them developed 10 prism diopters hypotropia following recession of the superior rectus muscle. Recession of the superior and inferior rectus muscle is a safe and effective treatment for the innervational upshoot and downshoot, respectively, in Duane's retraction syndrome.