Lateral rectus resection strabismus surgery in unilateral duane syndrome with esotropia and limited abduction.

Background: Resection of the lateral rectus in Duane retraction syndrome (DRS) with esotropia (ET) and limited abduction can be a useful component of surgical planning in specific circumstances, when combined with medial rectus (MR) recession. This article reports the results of a prospective series of patients for whom this approach was used successfully.

Methods: Seven patients were treated, aged 3 to 52 years, with uniltaeral DRS with the following features: 1) ET at least 25 PD; 2) "mild" retraction on adduction; 3) clinically normal adduction; 4) significantly limited abduction; 5) no or mild upshoots/downshoots; and 6) positive forced duction to abduction at surgery. surgery involved MR recession up to 5.0 mm and LR resection of maximum 3.5 mm. Postoperative followup was at least 6 months in all cases.

Results: ET angles ranged from 25 to 32 PD; abduction limitations ranged from -3.5 to -4. All patients had face turn postures preoperatively. Postoperatively, the binoclar alignment in primary position was orthotropia and head postures wre eliminated in all patients. Abduction postoperatively ranged from -1 to -2.5; adduction ranged from -0.5 to -1. Two patients had minimal worsening of upshoots and downshoots after surgery.

Conclusion: In treating DRS with ET and limited abduction, a small LR resection can be a safe and effective component of surgery. It has a low risk of worsening retraction or "crippling" adduction when done in appropriate cases.