Refractive features and amblyopia in Duane's Retraction Syndrome: A review of the 582 patients.

PURPOSE: To report the visual and refractive characteristics and the prevalence of amblyopia in patients with different types of Duane's Retraction Syndrome (DRS). METHOD: This retrospective study was performed on hospital records of 582 DRS patients at Farabi Hospital, Iran, from 2012 to March 2022. RESULTS: The mean age of patients was 19.4 ± 11.9 (range, 3-70) years [335 (57.6 %) females and 247 (42.4 %) males (P < .001)]. DRS type I, II, III, and IV were presented in 347 (59.6 %), 148 (25.4 %), 82 (14.1 %), and 5 (0.9 %) patients, respectively. There were 530 (91.1 %) patients with unilateral and 52 (8.9 %) with bilateral involvement. In the unilateral patients, the DRS eyes' corrected distance visual acuity (CDVA) and astigmatism were significantly worse than the Non-DRS Eyes (P < .001). The mean amount of all refractive and visual parameters in bilateral patients' right or left eyes was significantly lower than in unilateral patients' non-DRS eyes (all P < .05). Anisometropia was observed in 75(12.9 %) of the patients. Amblyopia was observed in 18.5 % (98 patients) and 36.5 % (19 patients) of unilateral and bilateral DRS patients, respectively (P < .001). In unilateral patients, amblyopia was found in 57 (16.4 %) patients with Type I, 22 (14.9 %) patients with Type II, 16 (19.5 %) patients with Type III, and 3 (60 %) patients with Type IV. Forty-four (37.6 %) of patients with amblyopia had anisometropia. CONCLUSION: This large-scale study indicates that DRS types differ in terms of refractive error, visual acuity, and the prevalence of amblyopia and anisometropia. Clinicians should be aware of the clinical features associated with different types of DRS.

Clinical Features of Duane Retraction Syndrome: A New Classification.

PURPOSE: We sought to provide a new classification system for Duane retraction syndrome (DRS) according to type and angle of strabismus during primary gaze and to analyze the clinical features of each DRS type. METHODS: The medical records of 65 DRS patients who visited the department of pediatric ophthalmology at Seoul National University Children's Hospital between 2010 and 2017 were retrospectively analyzed. Patients whose angle of exotropia at primary gaze exceeded 3 prism diopters (PDs) were classified as "Exo-Duane," those whose angle of strabismus at primary gaze did not exceed 3 PDs were classified as "Ortho-Duane," and those whose angle of esotropia at primary gaze exceeded 3 PDs were classified as "Eso-Duane." RESULTS: Among 65 DRS patients, Ortho-Duane was the most common (53.8%) type, followed by Eso-Duane (33.8%) and Exo-Duane (12.3%). The mean age at diagnosis was significantly higher in the Exo-Duane group than the Ortho-Duane or Eso-Duane group (p = 0.003 and p < 0.001, respectively). A predominance of left eye involvement was observed in the Ortho-Duane (62.9%) and Eso-Duane (90.9%) groups. The frequencies of upshoot, downshoot, fissure narrowing, and globe retraction were not significantly different among the subgroups. Head-turn was more frequent in Eso-Duane patients than in Exo-Duane or Ortho-Duane patients (p = 0.001 and p < 0.001, respectively). Myopia accounted for the most common refractive error among Exo-Duane patients (71.4%), while hyperopia was found more often in both Ortho-Duane (64.7%) and Eso-Duane (85.0%) patients. The majority of patients showed gross stereoacuity (93.1%), and a large proportion had good stereoacuity (Exo-Duane 60.0%, Ortho-Duane 81.3%, Eso-Duane 87.5%). CONCLUSIONS: Our newly proposed classification of DRS according to type and angle of strabismus at primary gaze was practically useful and showed potential for use as an objective guideline in the clinical setting.

Duane retraction syndrome: series of 441 cases.

PURPOSE: To determine the demographic and clinical profile of various subtypes of Duane retraction syndrome (DRS). METHODS: Retrospective case series of 441 patients. RESULTS: Of the total 441 patients, 389 (88.2%) and 52 (11.8%) patients had unilateral and bilateral involvement, respectively. In both unilateral and bilateral cases, type I was the most common subtype, followed by types III and II. Mean age of presentation of type I DRS was significantly less (13.3 years) compared with types II (23 years) and III (21.9 years) (P < .05). Unilateral disease was significantly more common in females (57. 6%, P = .006), whereas there was no gender predilection in bilateral cases (P = .77). Type 1 DRS was significantly more common among females (57.96%, P = .003) compared with males, whereas there was no such gender predilection in types II and III. The left eye was more commonly involved in patients with types I and III (P < .05), whereas in type II there was no such predilection for any eye involvement. Esotropia was more common in patients with bilateral disease (53.8%) and exotropia was predominant ocular deviation in patients with types II and III (70% and 66.67%, P = .03). There was no difference in the type of deviation in patients with type I (P > .05). Upshoots and downshoots were more common in unilateral disease and types I and III compared with type II. CONCLUSION: Unilateral and bilateral DRS show considerable differences in gender distribution, associated ocular deviation, overshoots, and ocular and systemic associations.

Duane's retraction syndrome: a retrospective review from Kathmandu, Nepal.

PURPOSE: The aim was to study the clinical characteristics of Duane's retraction syndrome (DRS) in Nepalese patients. METHOD: Medical records from 52 cases of DRS from May 2003 to April 2010 were retrospectively reviewed for age, gender, laterality and clinical characteristics. Forty-one case records (78.8 per cent) that had complete clinical findings were considered for further evaluation. Examination included visual acuity by Snellen chart, refraction, associated horizontal and vertical strabismus in primary gaze, upshoot and downshoot on attempted adduction, binocular vision assessed with the Worth four-dot test on adopted gaze and stereopsis examined with the Titmus stereo test. RESULTS: DRS type I was the most common type observed in 73.2 per cent of cases, followed by DRS type II (14.6 per cent) and DRS type III (12.2 per cent). It was more common in female patients (58.5 per cent) than male patients (χ(2) = 4.6, df = 1, p = 0.03). DRS was more common in the left eye (68.3 per cent) than the right eye and unilaterally present in 95.1 per cent of subjects. In primary gaze, orthotropia (41.5 per cent) was more common than exotropia (34.1 per cent) and esotropia (24.4 per cent) and vertical strabismus was present in 24.4 per cent of subjects. Upshoot and downshoot on attempted adduction was seen in 14.6 and 9.8 per cent, respectively. Binocular single vision was present in 68.3 per cent of subjects by Worth four-dot test at near. Stereopsis of 3,000 seconds of arc was present in 9.8 per cent, 100 to 200 seconds of arc in 14.6 per cent and 40 to 60 seconds of arc in 43.9 per cent with the Titmus stereo test. CONCLUSION: DRS is more common in female patients and the left eye. DRS type I is the most common type.

Risk factors for consecutive exotropia after vertical rectus transposition for esotropic Duane retraction syndrome.

PURPOSE: To define risk factors for postoperative exotropia after vertical rectus transposition (VRT) for Duane syndrome. METHODS: The records of patients with Duane syndrome who underwent augmented VRT were retrospectively reviewed; those with postoperative exotropia (study group) were compared with those with postoperative esotropia/orthotropia (controls). RESULTS: A total of 51 patients were included, of whom 14 were exotropic postoperatively. Of the 14, 6 became exotropic after augmented VRT, and 8 who were initially esotropic became exotropic after subsequent medial rectus muscle (MR) recession. Study subjects were significantly younger (2 ± 2 years vs 6 ± 10 years, P = 0.04) and demonstrated less restriction on intraoperative forced duction testing than control subjects. Subjects who became exotropic after MR muscle recession had significantly less esotropia at near (5.2(Δ) ± 6.5(Δ) vs 18.4 (Δ) ± 7.9(Δ) esotropia, respectively; P = 0.005) and in adduction (1(Δ) ± 2(Δ) exotropia vs 3(Δ) ± 4(Δ) esotropia, respectively; P = 0.02) than control patients who also underwent VRT and MR muscle recession. Forced duction testing was also significantly different among these groups (P = 0.03). CONCLUSIONS: Risk factors for exotropia after augmented VRT include younger age and less restriction on forced duction testing. Additional risk factors for exotropia after VRT and subsequent MR muscle recession include preoperative exotropia in adduction and smaller deviation at near. These factors may be useful in distinguishing patients at risk, allowing for consideration of less powerful procedures.

Differences in epidemiological and clinical characteristics between various types of Duane retraction syndrome in 331 patients.

PURPOSE: To determine the differences in various epidemiologic and clinical characteristics among types I, II, and III of unilateral Duane syndrome and between unilateral and bilateral Duane syndrome. METHODS: A retrospective chart review of 331 patients with the Duane syndrome (291 unilateral and 40 bilateral) was performed. Various characteristics studied included sex, age at presentation, laterality, manifest primary position horizontal deviation, upshoot and downshoot, amblyopia, and associated ocular and systemic abnormalities. RESULTS: Unilateral types I and III Duane syndrome were more common in the left eye and in female patients, whereas type II had no such predilection. The mean age at presentation was significantly greater in type III patients. Type I patients had an almost-equal frequency of esotropia and exotropia, type II had exotropia, and type III had exotropia more commonly than esotropia. The upshoots and downshoots were more common in types II and III. There was no difference in amblyopia among various types of Duane syndrome. Associated ocular abnormalities were more common in types I and III, and systemic abnormalities were more common in type I. A manifest primary position horizontal deviation was more common in bilateral Duane syndrome. Exotropia was more common in unilateral cases, whereas esotropia was more common in bilateral cases. CONCLUSION: Unilateral types I, II, and III Duane syndrome differ in the mean age at presentation, primary position horizontal deviation, upshoot and downshoot, and associated ocular and systemic abnormalities. Bilateral Duane syndrome differs from the unilateral only in the primary position horizontal deviation.

Duane's retraction syndrome, a case series from Iran.

PURPOSE: To determine the relative prevalence of Duane's retraction syndrome (DRS) in a population of Iranian strabismus cases and to describe the clinical features. METHODS: Retrospectively, a population of 7,349 strabismus cases visited during 2000-2003 were evaluated for the diagnosis of DRS. Data regarding onset (noticed age), type, head turn, primary position deviation, narrowing of the palpebral fissure, leash phenomenon, refractive error, amblyopia, and history of surgery were collected. Chi-square test and Student's t-test were used. RESULTS: About 125 DRS cases were diagnosed (prevalence: 1.7%). The noticed age of the syndrome was at birth in 35.6%, during infancy in 25.4%, or childhood in 39.0%; the age at referral ranged from 3.5 months to 65.0 (median: 10.0) years. The female/male and left/right eye involvement ratios were 3:2 and 3.5:1, respectively. The syndrome was of type I in 87.0%, II in 6.5%, and III in 5.7%; 7.2% were bilateral. Horizontal deviations existed in 76.0% and vertical deviations in 12.8%. 26.8% had different degrees of amblyopia. Leash phenomenon was detected in 37.6% of cases. Head turn, primary position deviation (without turn), and orthophoria were observed in 71.2%, 13.6%, and 15.2%. Surgery had been performed in 71.2% of the cases. Vertical deviations and leash phenomenon were more common in types II and III and hypermetropia in type I (P values: 0.036, <0.001, and 0.025, respectively). CONCLUSION: Basic features of our series seem to be comparable with previous reports. The incidences of bilateral involvement and type III syndrome were lower. The proportion of cases with head turn was higher and surgery was performed more frequently.

Duane retraction syndrome on the Arabian Peninsula.

PURPOSE: To describe the clinical features of patients from the Arabian Peninsula with Duane retraction syndrome (DRS). METHODS: Retrospective chart review of patients referred to the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia from 1982 to 2003 with a diagnosis of DRS. Patients having had prior strabismus surgery were excluded. RESULTS: Of 404 DRS patients, 347 (86%) were unilateral, 57 (14%) were bilateral, and 111 (27%) had amblyopia. There were 221 (55%) females and 182 (45%) males. The Huber classification was as follows: 315 (78%) Type I, 16 (4%) Type II, and 77 (19%) Type III. Of the 57 bilateral cases, 25 (44%) were female and 32 (56%) were male. DISCUSSION: Overall, the clinical features of DRS patients referred to a Riyadh eye hospital are similar to those reported in series throughout the world. However, our referred bilateral DRS patients are more commonly male. The clinical features of bilateral DRS deserve further worldwide study.

[A clinical analysis of 25 cases with Duane's retraction syndrome combined with congenital crocodile tears].

OBJECTIVE: To analyze the clinical manifestations of Duane's retraction syndrome (DRS) combined with congenital crocodile tears or gustatory-lacrimal reflex. METHODS: Twenty-five cases of DRS associated with congenital crocodile tears were retrospectively summarized. The clinical features, including sex, age at first visit, chief complaints, laterality, types of DRS, features of abnormal lacrimation and its associated ocular and non-ocular anomalies were analyzed. RESULTS: There were 8 males and 17 females with a male-to-female ratio of 1:2. Fifteen cases had binocular involvement and the remaining 10 cases were monocular involvement. In general, the association of the abnormal lacrimation and eye movement disorder in unilateral cases was ipsilateral, while in bilateral cases the abnormal lacrimation and the movement disorder were also bilateral except 3 cases of bilateral DRS with monocular crocodile tears and one case of unilateral DRS with binocular crocodile tears. CONCLUSIONS: Clinically, cases with Duane's syndrome combined with crocodile tears are relatively few. That sufficiently pay attention to and master its clinical characteristics is the basis for its correct diagnosis.

Síndrome de Duane: estudo retrospectivo de 41 casos / Fourty-one cases of Duane's Syndrome: retrospective study

Objetivos: Descrever as características de 41 pacientes acompanhados no departamento de Motilidade Ocular. Local: Hospital das Clínicas da Faculdade de Medicina da USP. Pacientes e Métodos: Estudo retrospectivo de 41 casos de Síndrome de Duane quanto às características clínicas oculares. Resultados: 22 pacientes do sexo masculino e 19 do feminino. Predominância do tipo I (75,6 por cento) e de acometimento do olho esquerdo (70,7 por cento). 92,6 por cento dos casos era bilateral. 24,4 por cento dos pacientes foram submetidos à cirurgia, com 70 por cento de bons resultados. Conclusão: Nosso estudo condiz com o relato na literatura quanto às características clínicas desta síndrome.

[Clinical features of 31 cases with bilateral Duane's retraction syndrome].

OBJECTIVES: To summarize the clinical features of 31 cases with bilateral Duane's retraction syndrome (DRS) and discuss its differential diagnosis. METHODS: We retrospectively summarized 31 cases with bilateral DRS from 1979 to 1996. Its clinical features including chief complaints, age and sex distribution, types of presentation, defects in abduction and adduction, retraction of the globe, upshots and downshots in abduction, etc. were analyzed. RESULTS: There were 14 males and 17 females with a female-to-male ratio 1 : 0.8. The chief complaints comprised 14 cases (45%) with ocular motility disorders and 10 cases (32%) with ocular deviations. The most common form of the syndrome was type 1 (29 cases, 94%), the remaining 2 cases (6%) with type III. Its clinical features consisted of retraction of the globe with narrowing of the palpebral fissure in attempted adduction, limitation in abduction with variable extent also in adduction, and upshot and/or downshot of the affected eye during adduction. CONCLUSIONS: In atypical cases, the retraction of the globe in adduction was not obvious and the diagnosis of DRS must be differentiated from the following ocular motility disorders, namely, abducens nerve palsy, Möebius syndrome, congenital oculomotor apraxia and congenital or infantile esotropia.

[Epidemiological and clinical aspects of Stilling-Turk-Duane syndrome]. / Aspects épidémiologiques et cliniques du syndrome de Stilling-Turk-Duane.

BASIS: In a retrospective study on 155 patients with Stilling-Turk-Duane's syndrome, we compare our results with those described in the literature. Particular focus was based on the different clinical entities observed. PATIENTS AND METHODS: Patients were selected from 8000 charts of cases of strabismus seen in the Ophthalmological Clinic of the CHU in Nantes between 1980 and 1995. An oculomotor assessment carried out for all of these patients allowed us to determine the clinical type according to Malbran's classification. Patients were classified on the basis of family history of oculomotor disorder and associated pathology. RESULTS: The incidence of this syndrome in the population of strabismic patients was 1.9%. The number of women affected was 83 (53.5%). The syndrome was unilateral in 121 cases (78.1%). The left eye (71.9%) was affected more frequently than the right. Clinical entities not described by Malbran's classification were found in 24% of cases. These were described and classified. The oculomotor disorder most frequently encountered was esotropia. The number of patients with a amblyopia was 51 cases (32.9%). The number of patients with a torticollis was 101 cases (65.1%). The number of cases with associated medical pathology was 38 (24.5%). This pathology was ocular in 17 cases (10,9%) and extra-ocular in 22 cases (14.2%). The number of patients with a family history of oculomotor disorder was 39 (22.2%) among which 9 (5.8%) had at least one family member with Stilling-Turk-Duane's syndrome. CONCLUSION: Data provided by this study allowed us to analyse the clinical and epidemiological features of the Stilling-Turk-Duane's syndrome. What is more, they allowed us to describe and classify clinical forms not described by Malbran's classification.

Cervico-oculo-acousticus syndrome with pregnancy.

Cervico-oculo-acousticus syndrome is a very rare entity with only 21 cases described in the world literature. A study of a case of this syndrome with pregnancy is presented. This primigravida, in addition to the classical triad of the syndrome, had other dysmorphic features such as short stature (141 cm), and marked thoracic kyphosis with restricted ventilatory capacity. Her physical activity during pregnancy was guided according to her respiratory status. In spite of marked thoracic kyphosis the cephalo-pelvic relationship was found to be adequate for a vaginal delivery. A healthy male baby weighing 3.8 kg was delivered by an outlet forceps at term. Puerperium was uneventful. The child was clinically normal at the age of 2 years.