Comparison of augmented superior rectus transposition with medial rectus recession for surgical management of esotropic Duane retraction syndrome

BackgroundMedial rectus recession (MRc) and vertical rectus transpositions are procedures used to treat esotropic Duane retraction syndrome. Recently superior rectus transposition (SRT) combined with MRc has also been shown to improve primary alignment and abduction. The purpose of this study is to compare the results of augmented (ie, with scleral fixation) SRT with or without MRc with either unilateral or bilateral MRc for treatment of esotropic Duane syndrome.MethodsThe medical records of patients who underwent surgery for esotropic Duane syndrome between May 2007 and February 2013 were retrospectively reviewed. Success was defined as alignment within 8Δ of orthotropia and abnormal head posture of <5°.ResultsThere were 8 patients in the SRT group (6 of whom had additional ipsilateral MRc) and 13 in the MRc group (6 unilateral and 7 bilateral). In the SRT group, the mean preoperative deviation was 20Δ of esotropia; the mean postoperative deviation, 3Δ. In the MRc group, the mean preoperative deviation was 24Δ of esotropia; the mean postoperative deviation, 4Δ. The success rate was 87% in the SRT group; 77%, in MRc group (P = 0.98). Mean abduction limitation improved from −3.6 to −2.4 units in the SRT group and from −3.6 to −3.3 units in the MRc group (P = 0.003). Induced vertical deviation or subjective torsion was not seen. Three patients in each group developed adduction limitation postoperatively.ConclusionsAlthough both the procedures successfully correct esotropia in Duane syndrome, SRT with or without MRc has the additional advantage of improving abduction.