Surgical outcome of superior rectus transposition in esotropic Duane syndrome and abducens nerve palsy.

Purpose: To evaluate surgical outcome of superior rectus transposition (SRT) in esotropic Duane syndrome (DS) and abducens nerve palsy.

Methods: Retrospective medical record analysis of all patients with esotropic DS and abducens nerve palsy treated with SRT at our center with minimum follow-up of 6 months. Primary outcome measures were esotropia in primary position and abduction limitation. Secondary outcome measures included head turn, stereopsis, and cyclovertical deviations.

Results: A total of 20 eyes of 19 patients were included: 9 with DS and 10 with traumatic abducens nerve palsy. One patient had bilateral esotropic DS. Mean age of DS patients was 12.5 ± 10.1 years; of abducens nerve palsy patients, 25.4 ± 11.3 years. Medial rectus recession (MRc) of 3.5 mm was additionally performed in 5 DS eyes. An adjustable MRc 5.6 ± 2.2 mm with or without augmentation suture was performed in all abducens nerve palsy patients. In DS patients, esotropia improved from 27.5Δ ± 5.4Δ to 3.6Δ ± 6.4Δ (P < 0.001), abduction limitation reduced from -3.8 to -1.8 (P < 0.001), and head posture improved from 20° to 4° (P < 0.001) at 6 months. In abducens nerve palsy patients, esotropia improved from 51.5Δ ± 18.8Δ to 6.1Δ ± 10.7Δ (P < 0.001), abduction limitation reduced from -3.8 to -2, and head posture improved from 25° to 8° (P < 0.001). Stereopsis improved in 4 patients (P = 0.12). No patient had vertical deviation or torsional diplopia.

Conclusions: In our patient cohort with esotropic DS or abducens nerve palsy, SRT reduced esotropia and improved abduction. Because of a long-term exotropic drift, initial undercorrection in the immediate postoperative period may prevent eventual overcorrection.