●AIM:To study the different treatment modalities needed in cases of Duane’s Retraction Syndrome(DRS).●METHODS:This prospective study undergone in more than four years,in Alexandria,included 238 patients of DRS,incl...●AIM:To study the different treatment modalities needed in cases of Duane’s Retraction Syndrome(DRS).●METHODS:This prospective study undergone in more than four years,in Alexandria,included 238 patients of DRS,including type I,162 patients(68%),type II 12 patients(5%)and type III 64 patients(27%).Surgery was indicated in 98(41%)of them,to eliminate abnormal head posture,deviation of the eye in primary position,severe retraction of the globe or cosmetically unacceptable upshoot with attempted adduction.●RESULTS:Type I was the most common and type II was the least.Females were predominant in this study,constituting 125 patients(52.5%),and males 113 patients(47.5%).Left eye was more affected,in 110 patients(46.2%),right eye in 91 patients(38.2%)and bilateral in 37 patients(15.6%).Amblyopia was found in 27 patients(11.3%)and treated in 13 patients under 10 years of age,by patching the normal eye.Ninety-eight patients(41%)were operated,the results were most satisfactory and a nomogram is followed in the surgical plan.●CONCLUSION:The surgical management is needed in less than half of the cases and should be planned for every case individually according to the clinical findings,planned nomogram and modified intraoperatively according to the anatomical findings during surgery.展开更多
Background Researches in ocular electromyography （EMG） and Magnetic resonance imaging （MRI） of patients with Duane retraction syndrome （DRS） suggest that there may be additional abnormalities such as paradoxical...Background Researches in ocular electromyography （EMG） and Magnetic resonance imaging （MRI） of patients with Duane retraction syndrome （DRS） suggest that there may be additional abnormalities such as paradoxical innervation between horizontal rectus muscles and vertical rectus muscles, hypoplasia of vertical rectus muscle and that oblique muscles may also contribute to the heterogeneity of the clinical manifestation of DRS. This paper reports the results of superior rectus recession for vertical deviation and A pattern in DRS Type III and discusses the pathogenesis of the disease. Methods Superior and lateral rectus recession were performed in 5 cases of Huber type III DRS to treat vertical deviation and A pattern strabismus. Before operation, MRI of the brain, brainstem, cavernous sinus, and orbits were performed. Results All subjects had unilateral limitation of both abduction and adduction, with palpebral fissure narrowing and globe retraction in adduction. Three cases had A pattern of strabismus, three cases had hypertropia. The abducens nerves （CN6） were either absent or hypoplasitic in the brainstem in all patients. Two eyes had larger oculomotor foramen. Two eyes had hypoplasia of the superior rectus and the inferior rectus. There was presumably a branch of the third cranial nerve （CN3） innervating the lateral rectus （LR） in one eye. While in another eye, two branches of CN3 sent into medial rectus were revealed. After surgery, vertical deviation in the primary position was reduced in all patients and A pattern was eliminated in 3 patients. One patient developed 10A consecutive esotropia postoperatively. Conclusion The results suggest that structural abnormalities of vertical muscle and abnormal orbital innervation may be related to vertical deviation and the presence of A pattern in DRS type Ⅲ. Recession of the superior rectus muscle seems to be a safe and effective treatment for vertical deviation and A pattern strabismus in DRS Type Ⅲ.展开更多
文摘●AIM:To study the different treatment modalities needed in cases of Duane’s Retraction Syndrome(DRS).●METHODS:This prospective study undergone in more than four years,in Alexandria,included 238 patients of DRS,including type I,162 patients(68%),type II 12 patients(5%)and type III 64 patients(27%).Surgery was indicated in 98(41%)of them,to eliminate abnormal head posture,deviation of the eye in primary position,severe retraction of the globe or cosmetically unacceptable upshoot with attempted adduction.●RESULTS:Type I was the most common and type II was the least.Females were predominant in this study,constituting 125 patients(52.5%),and males 113 patients(47.5%).Left eye was more affected,in 110 patients(46.2%),right eye in 91 patients(38.2%)and bilateral in 37 patients(15.6%).Amblyopia was found in 27 patients(11.3%)and treated in 13 patients under 10 years of age,by patching the normal eye.Ninety-eight patients(41%)were operated,the results were most satisfactory and a nomogram is followed in the surgical plan.●CONCLUSION:The surgical management is needed in less than half of the cases and should be planned for every case individually according to the clinical findings,planned nomogram and modified intraoperatively according to the anatomical findings during surgery.
基金This work was supported by a grant from the National Natural Science Foundation of China （No. 81070762）.
文摘Background Researches in ocular electromyography （EMG） and Magnetic resonance imaging （MRI） of patients with Duane retraction syndrome （DRS） suggest that there may be additional abnormalities such as paradoxical innervation between horizontal rectus muscles and vertical rectus muscles, hypoplasia of vertical rectus muscle and that oblique muscles may also contribute to the heterogeneity of the clinical manifestation of DRS. This paper reports the results of superior rectus recession for vertical deviation and A pattern in DRS Type III and discusses the pathogenesis of the disease. Methods Superior and lateral rectus recession were performed in 5 cases of Huber type III DRS to treat vertical deviation and A pattern strabismus. Before operation, MRI of the brain, brainstem, cavernous sinus, and orbits were performed. Results All subjects had unilateral limitation of both abduction and adduction, with palpebral fissure narrowing and globe retraction in adduction. Three cases had A pattern of strabismus, three cases had hypertropia. The abducens nerves （CN6） were either absent or hypoplasitic in the brainstem in all patients. Two eyes had larger oculomotor foramen. Two eyes had hypoplasia of the superior rectus and the inferior rectus. There was presumably a branch of the third cranial nerve （CN3） innervating the lateral rectus （LR） in one eye. While in another eye, two branches of CN3 sent into medial rectus were revealed. After surgery, vertical deviation in the primary position was reduced in all patients and A pattern was eliminated in 3 patients. One patient developed 10A consecutive esotropia postoperatively. Conclusion The results suggest that structural abnormalities of vertical muscle and abnormal orbital innervation may be related to vertical deviation and the presence of A pattern in DRS type Ⅲ. Recession of the superior rectus muscle seems to be a safe and effective treatment for vertical deviation and A pattern strabismus in DRS Type Ⅲ.
