Vertical rectus muscle augmented transposition in Duane syndrome

Reduction or elimination of face turn and esotropia in the primary position while maintaining the largest possible diplopia-free field are the major surgical goals in Duane syndrome with esotropia. Unsatisfactory postoperative results may occur because of limitation in adduction, poor abduction, or induced vertical deviations. Recent reports have shown enhanced results from rectus muscle transposition techniques when a lateral posterior augmentation fixation is placed.

Preoperative and postoperative data of 2 groups of subjects who had Duane syndrome with esotropia in primary position and markedly reduced abduction were comparatively analyzed. Group A consisted of subjects who had transposition of both vertical rectus muscles to the lateral rectus muscle with a posterior lateral augmentation suture placed in each transposed muscle. Group B subjects had transposition of both vertical rectus muscles to the lateral rectus muscle without the posterior lateral augmentation suture.

A total of 32 subjects in group A and 22 subjects in group B were analyzed. In group A, anomalous head position improved 19.1 degrees +/- 10.3 degrees compared with group B subjects who improved 10.6 degrees +/- 5.8 degrees (P <.05). In group A, esotropia in primary position improved 16.4 +/- 9.2 PD compared with group B subjects who improved 8.5 +/- 6.9 PD (P <.05).

Subjects with Duane syndrome and esotropia in primary position who had undergone augmented transposition of the vertical rectus muscles obtained improved head position and better alignment in primary position and had a reduction in the incidence of reoperation for undercorrection when compared with similar patients who had undergone vertical rectus muscle transposition without posterior lateral augmentation sutures.