Session: Free papers Session III - Incomitant Strabismus

Surgical Management of Duane Syndrome with Limitation of Both Adduction and Abduction

Federico G VELEZ¹, Robert TAUSCHER², Stacy PINELES¹, Joshua JONES³

¹Stein Eye Institute, UCLA, Los Angeles, California, United States
²University of Alabama, Birmignham, Alabama, United States
³Heaton Eye Associates, Athens, Texas, United States

Background: Managing Duane syndrome with severe limitation to both adduction and abduction is challenging due to several factors,1 including misinnervation or absent innervation of the lateral rectus, the potential presence of accessory fibrotic bands, and ipsilateral medial rectus tightness.

Methods: We report six Duane syndrome patients with significant lateral rectus muscle misinnervation causing severe limitation to both abduction and adduction, globe retraction, pseudo-ptosis, and anomalous vertical movements. All six patients were treated with ipsilateral lateral rectus weakening of 10 mm; two also had a Y-splitting of the muscle. Three patients had simultaneous excision of an accessory lateral rectus muscle band. An augmented vertical rectus muscle transposition or augmented, modified muscle belly transposition procedure was performed laterally in 3 patients and medially in one patient. Two patients also underwent simultaneous recession of a cyclovertical muscle.

Results: Postoperatively, all patients were aligned within 10 prisms diopters (PD) of orthotropia. Adduction was markedly improved in all patients. Abduction was maintained or improved in all patients. No patient undergoing transposition surgery developed a vertical deviation in primary position. In the two patients with preoperative vertical deviations in primary position, the vertical deviation improved to less than 3 PD postoperatively.

Conclusion: In Duane syndrome patients with limited horizontal motility, weakening the ipsilateral lateral rectus, along with vertical rectus transposition and/or cyclovertical muscle surgery when indicated, may result in improved adduction, improved vertical movements, and less globe retraction. Additionally, it is important to explore and excise any accessory extraocular muscle bands that may be present.

1. Kekunnaya R, Kraft S, Rao VB, Velez FG, Sachdeva V, Hunter DG. Surgical management of strabismus in Duane retraction syndrome. J AAPOS. 2015;19(1):63-69.