Combined procedure shown beneficial in Duane syndrome, sixth nerve palsy

This retrospective case review found that combining superior rectus transposition (SRT) with adjustable medial rectus muscle recession (MRc) improved esotropia, head position, abduction limitation and stereopsis without inducing torsional diplopia in patients with Duane syndrome or sixth nerve palsy.

The study's authors reviewed the charts of 17 patients, 10 with Duane syndrome and seven with sixth nerve palsy, who underwent augmented temporal SRT with MRc and were followed for at least six weeks.

Combining SRT with MRc improved esotropia from 44 to 10 prism diopters (P < 0.001), reduced abduction limitation from -4.3 to -2.7 (P < 0.001) and improved compensatory head posture from 28° to 4° (P < 0.001).

Stereopsis was recovered in eight patients (P = 0.03). Three patients required reoperation, one for overcorrection and two for undercorrection. A new primary position vertical deviation was observed in two patients with complex sixth nerve palsy and none with Duane syndrome. No patient described torsional diplopia.

The authors conclude that the combined procedure was especially helpful in cases in which there may be simultaneous contracture of the medial rectus muscle because it allows an MRc to be combined with a transposition procedure without greatly increasing the risk of anterior segment ischemia.