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D Romero-Apis, G Campomanes, M Acosta, F Zavaleta; Surgical Innervational Approach Of 'y' Pattern Vertical Duane's Syndrome . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1480.
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Purpose:A new surgical innervational approach in treating significant divergence in upward gaze without inferior obliques overaction (Y Pattern vertical Duane's syndrome) is presented. There is clinical evidence of abnormal activation of lateral recti on elevation, due probably to abnormal wiring of these muscles by means of a superior branch of the III nerve in addition to the VI nerve . Simultaneous recession and suprainsertion of both lateral recti has given incomplete results.. The purpose of this procedure is to move both eyes upwards in equal amount creating a diminution of the active innervational stimulus needed to both superior and lateral recti when supraversion is intended to avoid the large divergent deviation in that position. Methods:Two patients with Y pattern vertical Duane's syndrome are presented. Case 1 was ortho in primary positíon, and had 60 p. d. of exodevíation in upward gaze, and no inferior oblique overaction. Case 2 was ortho in primary position and had 75 p. d. of exodeviation in upward gaze and no inferior oblique overaction. Both cases were opereted on by means of 7 mms bilateral inferior recti recession. Simultaneously a Jampolsky-Kuschner adyancement of the capsulo-palpebral ligament to avoid inferior lid retraction was performed - Changes in divergence in upward gaze are compared pre and postoperatively. Results:In all two patients an important amelioration of divergence in upward gaze was obtained . Case 1 improved from 60 p. d. of exodeviation in upward gaze in the pre-operative, to ortho in that position in the post-operative. Case 2 improved from 75 p. d of exodeviation in upward gaze in the preoperative to 10 p.d. of exodeviation in that positión in the postoperative. No inferior lid retraction was observed in both cases. Conclusion:Bilateral recession of inferior recti is an effective innervational surgícal procedure in treating Y pattern vertical Duane's syndrome.
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