Lateral Rectus Disabling and Simultaneous Modified Nishida Procedure for Exotropic Duane Retraction Syndrome

Area of Science:

• Ophthalmology
• Neurology
• Pediatric Surgery

Background:

• Exotropic-Duane Syndrome (XT-DRS) is a congenital disorder affecting cranial nerve innervation.
• XT-DRS presents with exotropia, anomalous head posture, limited adduction, and globe retraction.
• Poor convergence is common in XT-DRS due to anomalous lateral rectus muscle innervation.

Observation:

• Two patients with XT-DRS underwent simultaneous lateral rectus muscle disinsertion and periosteal fixation (LRDAPF) and modified Nishida procedure (MNP).
• One patient also received a contralateral lateral rectus recession.
• Surgical outcomes were evaluated for symptom reduction and convergence improvement.

Findings:

• The combined surgical approach led to a reduction in anomalous head posture, exotropia, globe retraction, and palpebral fissure narrowing.
• Abnormal eye movements, including upshoot and downshoot in adduction, were also diminished.
• Both patients demonstrated improved convergence after the surgical intervention.

Implications:

• This surgical technique offers a potential treatment for Exotropic-Duane Syndrome, addressing multiple characteristic symptoms.
• Improved convergence may enhance binocular function and visual outcomes for patients.
• Further research can explore the long-term efficacy and applicability of this combined surgical approach.