Clinical Spectrum and Surgical Management of Duane Retraction Syndrome: A Case Series of Ocular Alignment

Background: To describe the clinical spectrum of ocular alignment abnormalities in patients with Duane retractionsyndrome (DRS) and to evaluate the outcomes of individualized surgical management with particular emphasis on primaryposition ocular alignment, abnormal head posture, stereopsis, and horizontal abduction. Materials and Methods: Thisretrospective observational case series included 9 patients with clinically diagnosed DRS. Clinical records were reviewed forage and sex; affected eye; primary position ocular alignment; abnormal head posture/face turn; horizontal duction; upshoot/down shoot, globe retraction; visual acuity; stereopsis; measurement of deviation;surgical procedure; postoperativealignment; postoperative face turn; postoperative stereopsis; and postoperative horizontal duction . Stereopsis was assessedusing the Random Dot Stereo Test. Patients with clinically significant strabismus and/or abnormal head posture underwentindividualized strabismus surgery. Surgical procedures included medial rectus (MR) recession in patients with esotropia ,lateral rectus (LR) recession in patients with exotropia and combined MR recession with superior rectus transposition (SRT)in patients with marked abduction limitation.Patients with orthotropia in primary position , satisfactory binocular function,and no abnormal head posture were observed. Results: Nine patients with DRS were included. Five patients had esotropia,one had exotropia, and three were orthotropic in primary position. The preoperative horizontal deviation among thestrabismic patients ranged from 16 to 30 prism diopters (PD). Abduction limitation ranged from −2 to −4. All patients hadgood visual acuity and stereopsis as documented in the available clinical records. Six patients underwent surgical correction.Five patients with esotropia underwent MR recession, including one patient who underwent combined MR recession andSRT who had marked abduction limitation. One patient with exotropia underwent LR recession. Postoperatively, orthotropiain primary position was documented in all six operated patients. Abnormal face turn was documented as improvedpostoperatively, and stereopsis remained good. Residual abduction limitation persisted in several patients despite successfulprimary position alignment. Conclusion: DRS demonstrates a broad spectrum of ocular alignment despite persistenthorizontal duction abnormalities. In this series, individualized horizontal rectus surgery, with SRT in a selected patient withmarked abduction limitation, resulted in restoration of orthotropia in primary position and improvement in abnormal headposture. The persistence of abduction limitation despite successful alignment highlights the distinction between correction ofprimary position deviation.