Modified Nishida Procedure Combined with Lateral Rectus Disabling for Duane Retraction Syndrome

ABSTRACT

Duane retraction syndrome (DRS) is a complex congenital cranial dysinnervation disorder. The choice of surgical procedure in esotropic-DRS depends upon several factors that include: the amount of esotropia in the primary position, the presence and severity of palpebral fissure narrowing, globe retraction, presence of medial rectus muscle (MR) contracture, the likelihood of improving abduction, age of the patient, and the presence of binocularity and stereopsis. In the presence of MR contracture, MR recession is performed either alone (unilaterally or bilaterally) or in conjunction with Y splitting plus recession of the lateral rectus muscle (LR) for reducing globe retraction. MR recession, with or without adjustable sutures, may be simultaneously combined with partial thickness vertical rectus muscle transposition (VRT) or with superior rectus muscle transposition (SRT). We describe a novel combination of surgical procedures in the management of esotropic-DRS in two patients. In our first patient, following an initial MR recession combined with LR disinsertion and periosteal fixation (LRDAPF), a modified Nishida procedure was performed. In our second patient following a prior simultaneous MR recession and LR Y splitting with recession, we combined periosteal fixation of the LR with a modified Nishida procedure of the vertical rectus muscles.

KEYWORDS:

• Duane retraction syndrome
• lateral rectus disinsertion and periosteal fixation
• modified Nishida procedure
• esotropia
• Y split recession
• globe retraction
• palpebral fissure narrowing

Disclosure statement

The first and second authors do not have any financial conflict of interest. Dr. Kushner is on the scientific advisory board of NovaSight which does not pose any conflict of interest with this study. We have not received any funding or sponsorship for the study.

Additional information

Funding

This work was supported in part by an Unrestricted Grant from Research to Prevent Blindness, Inc. to the UW-Madison Department of Ophthalmology and Visual Sciences (Dr. Kushner).