Y-split Recession of Lateral Rectus With and Without Medial Rectus Recession in the Management of Exotropic Duane Retraction Syndrome With Significant Overshoot and Retraction.

Purpose: To compare the effectiveness of two surgical approaches in the management of exotropic Duane retraction syndrome (DRS) cases with significant overshoot and retraction.

Methods: A retrospective analysis was conducted on patients with exotropic DRS who experienced significant overshoot and globe retraction. Patients with incomplete medical records or previous strabismus surgery were excluded. Overshoot and retraction were graded on a scale of 1 to 3. Surgical outcomes were assessed based on exotropia correction, head turn correction, leash correction, and globe retraction correction.

Results: Twenty-one patients with unilateral type III exotropic DRS were included in the study. The Y-split recession of the lateral rectus muscle (LR) group comprised 13 patients who underwent Y-split recession of the LR alone and the Y-split recession of LR + ipsilateral MR recession group consisted of 8 patients who underwent Y-split LR recession combined with medial rectus (MR) recession. The average of exotropia and head turn correction was higher in the Y-split recession of LR group (15.76 prism diopters [PD], 18.46°) compared with the Y-split recession of LR + ipsilateral MR recession group (11.12 PD, 12.12°). On the other hand, the Y-split recession of the LR + ipsilateral MR recession group exhibited higher mean correction grades for leash and retraction (2.63 and 2.5, respectively) compared to the Y-split recession of LR group (2.31 and 1.92, respectively).

Conclusions: Both surgical approaches showed promising results in managing exotropic DRS cases with significant overshoot and retraction. Y-split LR recession combined with MR recession could possibly be a better surgical option in cases where severe retraction and overshoot are the main issues. Further investigations with larger sample sizes are necessary to validate these findings and determine the optimal surgical approach. [J Pediatr Ophthalmol Strabismus. 2025;62(1):67-74.].