Y-Split Recession vs Isolated Recession of the Lateral Rectus Muscle in the Treatment of Vertical Shooting in Exotropic Duane Retraction Syndrome

Abstract

Purpose To compare the results of 2 surgical procedures in the management of vertical shooting in exotropic Duane retraction syndrome (XT-DRS). Methods This was a prospective, interventional study of consecutive patients with XT-DRS with vertical shooting on adduction operated on from August 2012 to January 2015. A total of 25 patients were identified and were divided into 2 groups: the Y-split (Y) group, which included 12 patients, who underwent Y-splitting with recession of the lateral rectus muscle (LR); and the isolated recession (R) group, which included 13 patients, who underwent isolated LR recession. Surgical outcomes in both groups were compared in terms of improvements in vertical shoots, ocular deviation, and face turn. Results Upshoot, downshoot, XT, and face turn showed significant postoperative improvement in both groups (p<0.001). When comparing the groups, the difference in the average correction of the upshoot and downshoot was statistically significant ( p = 0.0004 and 0.0174, respectively) in benefit of the Y-group. One case of horizontal overcorrection (consecutive esotropia) with another case of horizontal undercorrection (persistent XT) were reported postoperatively in the Y-group. Conclusions In our series, both procedures achieved comparable results in the correction of XT and face turn. The combined Y-split recession procedure attained a more significant improvement of upshoot and downshoot but with higher incidence of postoperative complications.