Isolated lateral rectus recession with Y splitting versus anchoring of the lateral rectus muscle in patients with exotropic Duane syndrome

Abstract

Purpose: To compare the outcome of two surgical procedures used to treat up- and downshoots in Duane retraction syndrome associated with exotropia.

Methods: The medical records of patients with exotropic Duane retraction syndrome seen at a single tertiary care facility from 2009 to 2012 were retrospectively reviewed. Patients were divided into two groups, one comprising patients treated with Y splitting and recession of the lateral rectus muscle; the other, patients treated with anchoring of the lateral rectus muscle to the lateral palpebral ligament. Surgical outcomes were compared in terms of deviation, head turn, up- and downshoot, and duration of surgery.

Results: A total of 15 patients were included, 7 treated by Y splitting and recession and 8 by anchoring of the lateral rectus muscle. Both groups were comparable in terms of age, sex, laterality, best-corrected visual acuity, mean deviation in primary position, and preoperative head turn to the affected side. Torticollis decreased from 27.9° ± 6.4° to 2.6° ± 4.4° in the Y-split group and from 22.5° ± 5.9° to 1.6° ± 3.1° in the anchoring group (P < 0.001 [95% CI]). Exotropia decreased from 26.4(Δ) ± 5.6(Δ) to 2.28(Δ) ± 4.07(Δ) in the Y-split group and 26.9(Δ) ± 5.3(Δ) to 1.5(Δ) ± 6.88(Δ) in the anchoring group (P < 0.001 [95% CI]). The up- and downshoots decreased markedly in the both groups (P = 0.7 for upshoots and P = 1 for downshoots). The mean operating time was 15.3 ± 2.0 minutes for Y splitting plus recession and was 8.3 ± 1.8 minutes for anchoring.

Conclusions: In our patient cohort, the two procedures yielded comparable results in terms of the correction of the horizontal position deviation, head posture, and up- and downshoots.