Advances in treatment of Duane retraction syndrome

Duane retraction syndrome (DRS) is an abnormal eye movement disease caused by congenital cranial dysinnervation.Treatment of DRS is challenging because of the variety of clinical features with different types of strabismus in the primary position, different degrees of limitation of abduction/adduction, and different degrees of muscle contraction.It is more clinically meaningful to categorize patients as having esotropia, exotropia or orthostatic DRS based on the degree of strabismus in the primary position.The treatment plan for DRS should be individualized by considering the degree of strabismus in the patient’s primary position, the severity of abnormal head position, the amount of ocular deviation, abnormal head position, degree of globe retraction, combined with or without upshoot or downshoot.The main treatment options for DRS patients having monocular esotropia include monocular recession of the medial rectus muscle, superior rectus transposition only or combined with medial rectus muscle recession, binocular recession of the medial rectus muscle, and combination of recession of the medial rectus muscle and a small amount of lateral rectus muscle resection in the affected eye.The treatment plan for DRS patients having unilateral exotropia DRS includes lateral rectus muscle recession surgery for the affected eye and lateral rectus muscle recession surgery for bilateral asymmetry.The preferred surgical method for DRS patients having bilateral esotropia is bilateral recession of the medial rectus muscle.Bilateral exotropia DRS is a rare type of DRS, and the surgical plan needs to be individualized.Abnormal neural innervation in DRS patients can lead to joint contraction of the medial and lateral rectus muscles during eye rotation, resulting in eye retraction.Therefore, patients can be treated through extensive recession of the medial and lateral rectus muscles.The Y-shaped split of the lateral rectus muscle with or without lateral rectus muscle recession surgery can treat the upshoot or downshoot of the eyeball caused by the DRS lateral rectus muscle mechanical reins effect.For young children with DRS and suitable DRS cases, extraocular muscle injection of botulinum toxin can be used as an alternative therapy.This paper reviews the latest views and strategies on DRS treatment, and discussed the advantages, disadvantages and possible complications of these procedures.

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