Superior or inferior rectus transposition in esotropic Duane syndrome: a longitudinal analysis

To evaluate the results of superior rectus transposition (SRT) or inferior rectus transposition (IRT) in esotropic Duane syndrome.

The medical records of patients with esotropic Duane syndrome who underwent ciliary vessel-sparing SRT or IRT by a single surgeon in private practice were included. Pre- and postoperative head posture, primary position deviation, fundus torsion, collapse in pattern, and improvement in ductions were analyzed between groups.

A total of 21 patients were included: 7 had a V-pattern esotropia and/or larger abduction deficiency in downgaze compared to upgaze and underwent IRT; 14 underwent SRT of which 6 had A pattern and/or larger abduction deficiency in upgaze compared to downgaze. Orthotropia within 10^Δ of esotropia was achieved in 10 patients (71.4%) with SRT and 4 patients (57.1%) with IRT. Pattern was reduced and abduction improved in all patients. The improvement in abduction was slightly better in elevation after SRT compared with IRT (1.7 ± 1 vs 1.4 ± 0.7; P = 0.4) and in depression after IRT compared to SRT (2 ± 1.2 vs 1.1 ± 0.7; P = 0.05).

Both SRT and IRT procedures effectively correct the head posture and primary position deviation in esotropic Duane patients. SRT can be advantageous in patients with an A pattern or more limitation of abduction in elevation; IRT, in patients with a V pattern or more limitation of abduction in depression.