Medial Rectus Recession After Vertical Rectus Transposition in Patients With Esotropic Duane Syndrome

Objective: To describe preoperative characteristics and postoperative results among patients with esotropic Duane syndrome who underwent vertical rectus transposition with vs without subsequent medial rectus recession (MRR). Methods: Clinical records were compared of patients with esotropic Duane syndrome who underwent vertical rectus transposition with (study group) vs without (control group) subsequent MRR. Results: Twenty-three study group members and 26 control group members were identified. Preoperative characteristics that differed between groups were the mean (SD) primary position deviation (20 [7] prism diopters of esotropia [Delta ET] for the study group vs 15 [9] Delta ET for the control group, P=.002) and the mean (SD) adduction deviation (1.4 [4.0] Delta ET for the study group vs 2.5 [4.0] Delta exotropia for the control group, P=.04). Forced duction testing (FDT) revealed greater restriction to abduction (17 [7]degrees for the study group vs 23 [6]degrees for the control group, P=.002). After vertical rectus transposition, study group members had significantly greater mean (SD) ET (16 [7] Delta ET vs 0.4 [0.6] Delta ET for the control group, P<.001) and torticollis (10 [4]degrees vs 1 [5]degrees for the control group, P<.001) and significantly less mean (SD) abduction (-3.0 [-0.6] vs -2.0 [-0.7] for the control group, P=.20). After MRR, no significant difference was observed between groups in primary position deviation, but the study group had significantly less mean (SD) adduction (-1.0 [-0.8] vs -0.4 [-0.6] for the control group, P<.003). Conclusions: Risk factors for requiring MRR after vertical rectus transposition include greater ET in the primary position and in the adducting field of gaze, as well as greater restriction to abduction on intraoperative FDT. Postoperative results of patients who required MRR were similar to those of patients who did not require MRR.