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J. L. Schneider, E. R. Crouch, Jr., E. R. Crouch, III; An Innovative Approach to Transposition Surgery is Effective in Treatment of Type III Duane's Syndrome. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3012.
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To evaluate superior rectus transposition in treating Duane’s retraction syndrome (DRS) Type III.
This study analyzes the surgical treatment of two patients who presented to a single practice with DRS Type III. Prior to surgical intervention, patients underwent testing including visual acuity, slit lamp and dilated fundus exams, alternate cover testing, duction and version assessment. Sensory testing also included binocular visual field, Titmus stereopsis and Ishihara color plate testing. Both patients demonstrated a gross deficit in binocular visual field analysis and stereopsis, in addition to motility abnormalities. One patient, who had undergone eye muscle surgery in the past, had no deviation on primary gaze, and the other patient had 10 diopters of exotropia on primary gaze. Both patients demonstrated clinically significant (-2 to -3) underaction of both the lateral and medial recti, and retraction of these muscles was confirmed via forced duction testing in the surgical suite prior to the procedure.Surgical intervention on both patients was performed by the same pediatric/strabismus ophthalmologist and included transposition (with or without recession) of the superior rectus to the medial rectus along the spiral of Tillaux. For both patients, all testing performed pre-operatively was repeated at one month following the surgery.
Prior to surgery, patients had reduced binocular field of vision was 109-115 degrees horizontally and 105-106 degrees vertically. The minimum and maximum binocular field of vision in any gaze was 35-37 and 70-73, respectively. Post-operatively, the binocular field of vision increased by 25-45 degrees horizontally and 10-11 degrees vertically with a new minimum and maximum of 45-53 and 72->80.
Superior rectus transposition to the medial rectus along the spiral of Tillaux is recommended as an initial procedure in Duane’s syndrome type III. This technique improves eye motility, but more importantly, it improves binocular field of vision which greatly impacts a patient’s quality of life with improved peripheral fusion.
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