Functional Outcomes in Exotropic Duane’s Retraction Syndrome

1. Functional Outcomes in Exotropic Duane’s Retraction Syndrome Nana Theodorou BMedSc(Hons) PhD John Burke MRCP FRCS FRCOphth Directorate of Ophthalmology, Orthoptic Department, Royal Hallamshire Hospital, Sheffield, UK Introduction Surgical goals for Duane’s Retraction Syndrome (DRS)1 are to improve ocular misalignment and to decrease or eliminate horizontal deviation and an anomalous head position (AHP). Additional surgical goals are to improve a cosmetically unacceptable up/downshoot, and significant globe retraction. The goal of enhancing stereoacuity and ocular ductions are uncommonly described in relation to surgical outcomes in this condition. Method • A retrospective study looked at 14 patients with DRS and symptomatic exotropia (XT) who had surgery to evaluate the pre-operative and post-operative characteristics and to explore stereoacuity (SV) and subjective patient satisfaction as successful outcome measures. The period reviewed was between 1995 and 2010. • Outcome measures: • Prism cover test (PCT) for near and distance fixation with glasses if worn in primary position without the AHP. • The type and size of AHP as graded by estimation. • The presence and quality of SV was measured with the Frisby stereotest for near with glasses if worn. • Ocular motility grading for each eye abduction, adduction, and up/downshoots were recorded. • Patient satisfaction as documented in the notes. Table 1. Summary of patient data pre-op and post-op (HT hypertropia, X exophoria, HoT hypotropia, FT face turn, LR lateral rectus, MR medial rectus, Rc recession, Rs resection, adj adjustable, conj conjunctiva, Sup suppression). Results Conclusions References This study shows successful patient outcomes relating to better alignment in primary position, reduced AHP, improved SV, linked to patient satisfaction. 86% had a residual angle within 10PD, 78% had a reduction in AHP, 64% had an improvement in SV and the post-operative restriction improved in 79% of patients but it was not statistically significant and was never eliminated. 57% of patient with up shoots or down shoots pre-operatively were corrected post-operatively. Reported patient satisfaction was 93%. Treatment of exotropic DRS is considered more challenging than the more common esotropic group. The preferred reported method is recession of the lateral recti2,3. This study demonstrates that successful subjective and objective outcomes can be achieved without a statistically significant improvement in summative horizontal muscle ductions, namely improved AHP, improved primary position alignment and often unexpected improvements in documented stereoacuity. Patient satisfaction complements the clinical outcome measures. 1. Duane A. Congenital Deficiency of Abduction associated with impairment of adduction, retraction movements, contraction of the palpebral fissure and oblique movements of the eye. Archives of Ophthalmology. 1905; 34: 133-502. 2. Kraft SP, O’Donogue EP, Roarty JD. Improvement of compensatory head postures after strabismus surgery. Ophthalmol 1992;99:1301–8. 3. Barbe ME, Scott WE, Kutschke PJ. A simplified approach to the treatment of Duane’s syndrome. Br J Ophthalmol. 2004; 88: 131-138. .