Evaluation of Augmented Temporal Superior Rectus Transposition Combined with Adjustable Medial Rectus Recession in Sixth Nerve Palsy and Esotropic Duane Syndrome Type 1
Adeel Suhail Sethi, Medical Student; Tobias Emil Torp-Pedersen, MD, PhD; Claes Sepstrup Loenkvist, MD; Bente Baun Iversen, Orthoptist; Morten Dornonville De La Cour, MD, DMSci; Jon Peiter Saunte, MD
Department of Ophthalmology
Rigshospitalet, University of Copenhagen, Denmark
Introduction: Treatment of 6th nerve palsy(CN6p) and Duane syndrome(DUANE) by a combined augmented Superior Rectus transposition(aSRt) and Medial Rectus recession(MRc) was introduced by Mehendale et al. in 2012(1). We wanted to evaluate the efficacy of this procedure in our patients.
Methods: In a retrospective case-review of 27 patients (30 eyes) who underwent combined aSRt and MRc for CN6p or DUANE, we studied the change in abnormal-head-posture(AHP), Abduction-Restriction(AR) graded from -5 to 0, the angle of esotropia in Primary Position(PP), and the change in stereopsis. We used short-tag-noose adjustable suture on the medial rectus in 19 patients; six required reoperations, four underwent adjustments; follow-up mean was 5.8 months.
Results: Preoperative AHP was found in 24/27 patients. AHP was corrected in 10, reduced in 11, and not quantified in five patients. Preoperative AR was reduced from a mean of -4.3 to -2.7 at follow-up with a mean change of -1.57(CI95%:[-1.98;-1.15],P<0.0001). Ocular deviation in PP at near was reduced from a mean of 33.3PD to 3.9PD at follow-up with a mean change of 29.4PD(CI95%:[22.4PD;36.5PD],P<0.0001). Ocular deviation in PP at distance was reduced from a mean of 38.7PD to 5.0PD at follow-up with a mean change of 33.7PD(CI95%:[26.9PD;40.4PD],P<0.0001). Eight patients had gained stereopsis, four remained non-stereoptic, and 13 were not quantified. The induced vertical deviation in PP was observed in 10 patients.
Discussion: Mehendale et al.(1) found improved AHP from 28 degrees to 4 degrees, mean AR from -4.3 to -2.7 and deviation in PP from 44PD to 10.1PD. Furthermore, stereopsis was recovered in 8/17 patients, and the induced vertical deviation was observed in 2/17 patients. In our study, we found similar effects on these outcomes.
Conclusion: aSRt combined with MRc is effective in reducing AHP, AR, and ocular misalignment in CN6p and DUANE. The effects of this procedure are persistent and may reduce these patients’ needs for further surgery in the future.
References: 1: Mehendale et al. Superior Rectus Transposition Combined with Medial Rectus Recession for Duane Syndrome and Sixth Nerve Palsy. (2012).