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S.C. Johnston, E.R. Crouch, Jr., E.R. Crouch; An Innovative Approach to Transposition Surgery is Effective in Treatment of Duane's Syndrome With Esotropia . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2475.
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To evaluate superior rectus transposition in treating Duane’s Syndrome with Esotropia.
This retrospective case review study analyzes the surgical treatment of fifty–two patients with Duane’s Syndrome Type I. Patients were followed over a fifteen year period from 1990 to November 2005. Patient age ranged from six months to fifty–four years. Initially, all patients had esotropia in primary position or significant face turn. Twenty–five patients (48%) had superior rectus transposition only for esotropia in primary gaze of less than fifteen prism diopters and/or significant face turn. Seven patients (14%) had superior rectus transposition and medial rectus recession for esotropia in primary between fifteen and twenty–five prism diopters. Seventeen patients (32%) had medial rectus recession alone for esotropia in primary measuring greater than twenty–five prism diopters. Three patients (7%) had both superior rectus and inferior rectus transposition. Surgical techniques will be described in detail.
Prior to surgery, the angle of face turn was ten to forty–five degrees. The esotropia angle was ten to thirty prism diopters in primary position. Preoperatively, all patients had full abduction rotations and limited abduction ability between –3 and –4 underaction of the lateral rectus muscle. No binocular fields extended past midline into abduction. Ninety–five percent of patients who had superior rectus transposition alone or combined with medial rectus recession had improvement of esotropia to less than ten prism diopters. Face turn was improved in one hundred percent of patients and was eliminated in seventy–two percent. Abduction was increased by fifteen to forty–five degrees. Binocular diplopia free fields increased between fifteen and forty–five degrees. There was no hypotropia or hypertropia noted in this subset of patients. In contrast, two of three (67%) patients who underwent superior rectus and inferior rectus transposition developed a hypotropia greater than ten prism diopters that required vertical rectus modifications at second surgery.
Superior rectus transposition is recommended as an initial procedure in Duane’s syndrome type I for deviations less than fifteen prism diopters. It can be combined with medial rectus recession for esotropia in primary from fifteen to twenty–five prism diopters and/or significant face turn. In patients with esotropia measuring greater than twenty–five prism diopters, superior rectus recession may be combined with medial rectus recession of both eyes.
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