Superior rectus transposition, medial rectus recession effective for esotropic Duane syndrome

This retrospective study found that the combination of superior rectus transposition and medial rectus recession was more effective than either procedure alone at improving abduction while allowing for a smaller recession to align the eyes and eliminate a compensatory head posture.

Superior rectus transposition with or without medial rectus recession has been introduced as an alternative to medical rectus recession alone for esotropic Duane syndrome. However, the authors say the effectiveness of these procedures has not been compared previously.

They reviewed the medical records of all 36 patients (37 procedures) with esotropic Duane syndrome who underwent surgical treatment in 2006 through 2012 at a pediatric ophthalmology/adult strabismus practice at Boston Children’s Hospital. Patients in the superior rectus transposition group underwent the procedure with or without medical rectus recession while those in the non-superior rectus transposition group underwent unilateral or bilateral medical rectus recession.

Abduction improved significantly in patients treated with superior rectus transposition compared with medical rectus recession alone. There was a comparable reduction of esotropia in straight-ahead gaze and head turn but the superior rectus transposition group had a larger preoperative esotropia.

By combining the two procedures, a significantly smaller medial rectus recession was required to treat the esotropia. There was also a trend toward better preservation of adduction in the superior rectus transposition group which matches the authors’ clinical impression.

Although this wasn’t confirmed by the study, the authors say that patients treated with superior rectus transposition probably will have a reduced likelihood of developing long-term undercorrection. In their experience, combining the two procedures is technically straightforward and allows for recession of a tight medial rectus muscle with transposition in a single procedure. It also allows for suture adjustment to reduce the effect if required. Therefore, they recommend superior rectus transposition with adjustable medial rectus recession for Duane syndrome in patients with larger amounts of esotropia.