An Analysis of 5 Duane's Retraction Syndrome Patients with Preoperative Abnormal Face Turn Reversal and (or) Worsening after Standard Horizontal Eye Muscle Surgery.

Abstract

Background and purpose: Although horizontal extraocular muscle rectus recession is an accepted treatment for abnormal face turn (AFT) in Duane's Retraction Syndrome (DRS), in some situations it can worsen or reverse the AFT. Patients referred to the author with this complication over a 4 year period (2002-2006) were reviewed to identify potential risk factors.

Methods: Retrospective medical record review of DRS patients referred because of reversal and (or) worsening of the preoperative AFT immediately after technically uncomplicated horizontal rectus eye muscle recession surgery.

Results: All five patients (5-9 years old, all girls) preoperatively had unilateral DRS (four Type I, one Type III), with significant co-contraction during attempted ipsilateral adduction, orthotropia in the preoperative AFT, normal vision in both eyes, and no other ophthalmic findings. Four patients had significant postoperative AFT reversal: three DRS Type I patients with original primary position esotropia of 20 prism diopters or less who developed postoperative primary position exotropia after large ipsilateral medial rectus recession (two bilateral, one unilateral), and one DRS Type III patient whose primary position exotropia persisted after moderate bilateral lateral rectus recessions with a posterior fixation myopexy suture to the the contralateral medial rectus muscle. The fifth patient had postoperative worsening of the original AFT: she was a DRS Type I patient with original primary position esotropia of 40 prism diopters who still had significant undercorrected primary position esotropia after large bilateral medial rectus recessions.

Conclusions: The amount of ipsilateral medial rectus recession for treatment of AFT in esotropic unilateral Type I DRS should be limited if significant preoperative co-contraction is present and the degree of primary position esotropia is small; otherwise, a significant reversal of the AFT may occur. Surgical matching of the DRS eye's duction limitation in the unaffected eye (for example, by posterior fixation suture or large recession) can potentially lead to a compensatory face turn in the direction of the duction limitation in the context of postoperative significant primary position strabismus.