Outcomes of primary vertical strabismus in Duane retraction syndrome
Reviewed by Fiona Rowe

In this study, the authors report the clinical profile and surgical outcomes in patients with Duane retraction syndrome (DRS) who presented with significant primary position hypertropia. This was a retrospective study of 590 patients with DRS, of which 18 had associated primary position vertical deviation – a frequency of 3%. There were 10 males and 8 females with median age of 21 years. Type III was in 13 cases, type I in 4 and type II in 1. There was 1 bilateral case and 3 had amblyopia. Primary position esotropia of median 30PD was present in 3 cases, 12 cases had primary exotropia of median 30PD, and 3 had only a vertical deviation in primary gaze of median 10PD. All had associated overshoots; 17 with upshoot and 1 downshoot. Surgery was performed in 10 cases with median angle of 25PD preoperatively reducing to 3.5PD postoperatively for horizontal angle and 10 to 6PD pre to postoperatively for vertical angle. Results from this study suggest patients with primary hypertropia and overshoots have a mixed mechanism of overshoots who may benefit from Y-split procedure as well as cyclovertical muscle surgery. Overall surgical success was 60% with significant reduction in primary position deviation.

Clinical profile and surgical outcomes of Duane syndrome with primary position hypertropia with or without coexisting horizontal deviation. 
Sachdeva V, Vepakomma T, Chandrasekharan A, Kekunnaya R.
STRABISMUS
2026;34(1):45–52.