Surgical Treatment of Face Turn, and Up and Down Shoot in Duane Retraction Syndrome

PURPOSE: To present the results of patients undergoing surgical treatment and determine clinical guidelines for the face turn, and up and down shoot in Duane retraction syndrome (DRS). METHODS: Thirty-four patients with DRS were treated with single horizontal rectus muscle recession, lateral rectus (LR) recession with Y-splitting, or LR recession with Y-splitting combined with medial rectus (MR) recession. The different treatment approaches were based on the angle of deviation in the primary position, versions, and ductions. In all patients, ocular alignment, face turn and up and down shoot were assessed preoperatively and postoperatively. RESULTS: The average standard deviation reduced from 18.5 +/- 6.5 prism diopters (PD) to 4.6 +/- 5.8 PD in horizontal rectus muscle recession and 14.4 +/- 5.5 PD to 1.6 +/- 2.8 PD in LR recession with Y-splitting. LR recession with Y-splitting combined with MR recession was effective in reducing globe retraction. Postoperative 4-mm LR recession with Y-splitting did not change ocular alignment; 7-mm LR recession with Y-splitting showed an average correction of 12.8 PD. Postoperatively, all patients presented a reduction in face turn; however, there was no statistically significant difference between the 2 procedures (Mann-Whitney U test, p = 0.620). CONCLUSIONS: Decisions regarding surgical approaches in DRS should be based on the amount of deviation in primary eye position, the expression of up and down shoot, and the degree of face turn. Surgeons planning Y-splitting of LR with MR recession must consider modifying the MR recession amount due to the smaller LR recession effect of Y-splitting compared with conventional LR recession.

Clinical Manifestation of Abnormal heal Posture

Medical records of one hundred tow patients with abnormal head posture who were seen at our clinic between 1994 and 1997 were reviewed. The mean age was 7.8 years and the abnormal head posture was detected at 2.1 years. Thirty-two of the patients were female and 70 were male. There were 65 cases with face turn, 19 with head tilt, 6 with chin up or down, 7 with combined head posture and 5 with head nodding. In etiologic aspect, there were 60 cases with infantile nystagmus, 18 with paralytic strabismus, 13 with horizontal or vertical strabismus, 5 with Duane`s retraction syndrome and 6 with the others. Infantile nystagmus was the most common etiology of face turn and paralytic strabismus was that of head tilt. Thirty-three among 38 patients who had surgical procedure showed improvement in head posture.