surgery for Duane's syndrome

March 13th, 2010
  • I want to find out about surgery for Duane's retraction syndrome type I. I would like to know what surgeons have the most experience in this operation and what results are being reported.


  • Dear ann21-ga; Thank you for allowing me an opportunity to answer your interesting question. I assume that you already have at least some working knowledge of this syndrome, which is basically a significant congenital misalignment of the eye(s). In the event that you do not, you might want to read these articles first and familiarize yourself with the condition before moving on: HANDBOOK OF OCCULAR DISEASE MANAGEMENT “Duane's Retraction Syndrome” http://www.revoptom.com/handbook/oct02_sec6_1.htm THE ENGLE LABORATORY “Research: Duane syndrome” http://web1.tch.harvard.edu/research/engle/duane.html Here are some interesting facts about Duane’s syndrome: “DRS more frequently occurs in the left eye than in the right, and in females more than in males. Bilateral involvement is less frequent than unilateral occurrence. In several large series, the ratio of right eye to left eye involvement was 1:3, the prevalence of bilaterality was 20 per cent, and there was a slight preponderance of females over males (54 per cent versus 46 per cent). This condition is found in approximately 1 per cent of individuals with strabismus. Clinical Manifestations The most characteristic clinical findings in DRS include an absence of abduction of an eye with slight limitation of adduction, retraction of the globe in attempted adduction, and up- and downshooting, or both in adduction. Huber, with the support of electromyography, provided a useful classification of DRS into three types: Type I. Marked limitation or complete absence of abduction, normal or only slightly restrict adduction, narrowing of the palpebral fissure and retraction of the globe on adduction, and widening of the palpebral fissure on attempted abduction. Electromyography shows absence of electrical activity in the lateral rectus muscle on abduction, but paradoxic electrical activity on adduction.” GEOMETRY.NET: HEALTH CONDITIONS – DUANE’S RETRACTION SYNDROME http://www.geometry.net/health_conditions/duane_retraction_syndrome.php In this study, 124 cases in which surgery was used to correct the misalignment(s), were examined in order to provide a reliable success rate for the treatments used: “MEDLINE/HealthSTAR 1995 - 2001 Author: Kubota, N, Takahashi, H, Hayashi, T, Sakaue, T, Maruo, T Affiliation: Department of Ophthalmology, Teikyo University School of Medicine, Tokyo, Japan. Title: Outcome of surgery in 124 cases of Duane's Retraction Syndrome (DRS) treated by intraoperatively graduated recession of the medial rectus for esotropic DRS, and of the lateral rectus for exotropic DRS. Source: Binocular Vision and Strabismus Quarterly, 2001 Spring, 16(1):15-22. Abstract: RESULTS: Both the primary eye position and the abnormal head posture were satisfactorily improved in 119 cases (89%) after surgery with a result rated "excellent" or "good" by a residual deviation of 7 degrees or less and a definitely improved abnormal head posture, for all types of DRS deviations. CONCLUSION: Recession of the appropriate horizontal rectus muscle is a safe and effective primary procedure for both the primary deviation and abnormal head posture in all types of DRS.” “Current Citations from 5/12/2001 Strabismus” http://med-aapos.bu.edu/Melvyl/51201s.html By all accounts surgery an acceptable and relatively reliable treatment for this condition in most cases, provided the condition is not compounded by other complicating diseases (thyroid problems, deformities, etc). Most all studies agree that surgery also does not eliminate the fundamental abnormality of innervation and while treatment may provide aesthetic, cosmetic and even corrective results, no surgical technique has been completely successful in eliminating the abnormal eye movements entirely. “Simple horizontal muscle recession procedures, vertical rectus muscle transposition procedures, or combinations of the two may be successful in improving or eliminating head turns and misalignment of the eyes. The choice of procedure must be individualized.” Obviously, I cannot recommend a particular surgeon to you and even if I could, most directories do not specify which of the many types of syndrome each physician treats (Duane Syndrome Type IA, 1B, 1C; Type 2A, 2B, 2C; Type 3A, 3B, 3C). However, I can try to help you with a strategy to narrow your seach for a specialist in this field. Here I have found some known specialists in the field of ophthalmic surgery (specifically with regard to Duane’s Retractive Syndrome) and a number of other sources who are well versed in this area of expertise. I recommend you contact them and see if they can give you a referral to someone in your area that can provide the services you need: Rudolph S. Wagner, MD Clinical Associate Professor Bd. Certified: Ophthalmology Training: Ed: UMDNJ-New Jersey Medical School (1978). Res: Thomas Jefferson University Hospital, PA.; UMDNJ-New Jersey Medical School. Fel:Wills Eye Hospital, PA. Clinical Interests: Botulinum toxin in the treatment of strabismus, cranial nerve palsies, ocular genetics, Duane's retraction syndrome, and spina bifida and ocular disease. For appointments, call (973) 972-2065 UNIVERISTY HOSPITAL – NEWARK, NEW JERSEY http://www.theuniversityhospital.com/physservdirectory/html/ophthalmology.htm Suqin Guo, MD Assistant Professor Training: Ed: Beijing Medical University, China (1981). Res: UMDNJ-New Jersey Medical School. Fel: Emory University, GA; Wills Eye Hospital, PA; Children's Hospital of New Jersey, NJ. Clinical Interests: Medical and surgical management of adult and pediatric cataracts, vertical strabismus, and Duane's Retraction Syndrome Other Languages Spoken: Chinese For appointments, call (973) 972-2065 UNIVERISTY HOSPITAL – NEWARK, NEW JERSEY http://www.theuniversityhospital.com/physservdirectory/html/ophthalmology.htm March of Dimes Birth Defects Foundation 1275 Mamaroneck Avenue White Plains, NY 10605 Tel: (914)428-7100 Fax: (914)997-4763 Tel: (888)663-4637 TDD: (914)997-4764 Email: resourcecenter@modimes.org Internet: http://www.modimes.org Schepens Eye Research Institute 20 Staniford Street Boston, MA 02114-2500 Tel: (617)912-0100 Fax: (617)523-3463 Email: geninfo@vision.eri.harvard.edu Internet: http://www.eri.harvard.edu NIH/National Eye Institute Building 31 Rm 6A32 31 Center Dr MSC 2510 Bethesda, MD 20892-2510 United States Tel: 3014965248 Fax: 3014021065 Email: 2020@nei.nih.gov Internet: http://www.nei.nih.gov/ NIH/Office of Rare Diseases Steve Groft, Pharm.D. 31 Center Drive,Rm 1B19, MSC 2084 Bethesda, MD 20892- Tel: (301)402-4336 Fax: (301)480-9655 Email: hh70f@nih.gov Internet: http://rarediseases.info.nih.gov/ord/ Genetic Alliance 4301 Connecticut Avenue NW Suite 404 Washington, DC 20008-2304 Tel: (202)966-5557 Fax: (202)966-8553 Tel: (800)336-4363 Email: info@geneticalliance.org Internet: http://www.geneticalliance.org National Organization for Rare Disorders P.O. Box 8923 New Fairfield, CT 06812-8923; Phone (203) 746-6518 Web site http://www.rarediseases.org Email orphan@rarediseases.org In the meantime, here you will find others who are discussing the condition and you may find that many of them have already researched the information you are seeking: YAHOO GROUPS http://groups.yahoo.com/group/duanes/messages/4140 YAHOO GROUPS – DUANE LINKS http://groups.yahoo.com/group/duanes/links SUPPORT GROUPS http://med-aapos.bu.edu/AAPOS/support.html SUCCESSFUL GOOGLE SEARCH FOR SUPPORT GROUPS ://www.google.com/search?hl=en&lr=&ie=UTF-8&oe=UTF-8&safe=off&q=%22Duane%27s+retraction+syndrome%22+%22SUPPORT+GROUPS%22 I hope you find that that my research exceeds your expectations. If you have any questions about my research please post a clarification request prior to rating the answer. I welcome your rating and your final comments and I look forward to working with you again in the near future. Thank you for bringing your question to us. Best regards; Tutuzdad-ga INFORMATION SOURCES HANDBOOK OF OCCULAR DISEASE MANAGEMENT “Duane's Retraction Syndrome” http://www.revoptom.com/handbook/oct02_sec6_1.htm THE ENGLE LABORATORY “Research: Duane syndrome” http://web1.tch.harvard.edu/research/engle/duane.html YAHOO GROUPS http://groups.yahoo.com/group/duanes/messages/4140 HEALTH LIBRARY – DUANE’S SYNDROME http://www.bromenn.org/library/healthguide/IllnessConditions/topic.asp?hwid=nord224 YAHOO GROUPS – DUANE LINKS http://groups.yahoo.com/group/duanes/links SUPPORT GROUPS http://med-aapos.bu.edu/AAPOS/support.html SUCCESSFUL GOOGLE SEARCH FOR SUPPORT GROUPS ://www.google.com/search?hl=en&lr=&ie=UTF-8&oe=UTF-8&safe=off&q=%22Duane%27s+retraction+syndrome%22+%22SUPPORT+GROUPS%22 SEARCH STRATEGY SEARCH ENGINE USED: Google ://www.google.com SEARCH TERMS USED: SURGERY DUANE'S RETRACTION SYNDROME "TYPE 1" SUCCESS RATE SURGERY DUANE'S RETRACTION SYNDROME "TYPE 1" “DUANE'S RETRACTION SYNDROME” “SUPPORT GROUPS” “DUANE'S RETRACTION SYNDROME” “MESSAGE BOARDS” DUANE'S RETRACTION SYNDROME







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