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The authors report the surgical outcomes of patients with exotropic Duane’s retraction syndrome (DRS) in a retrospective study of 73 patients; 67 unilateral cases. Patients had a mean age at surgery of 14.11 years (range 2-33). The left eye was affected in 69% and the right in 37.3%. There were 38 males and 35 females. None of the cases had amblyopia. Type 3 was the most common (77%) followed by type 1 (19%) and type 2 (1.3%). Two patients had synergistic divergence on adduction. The main indication for surgery was abnormal head posture in primary gaze (90%). Overshoots in adduction were present in 71%, and 37% had globe retraction. Unilateral lateral rectus recession was undertaken for 65% and bilateral recessions for 34%. Five patients had both medial and lateral recti recessions to address co-contraction. Y splitting of the lateral rectus for overshoots was undertaken in 56%. Exotropia in primary gaze was 23 ±14.04PD reducing to 9 ±8.7PD postoperatively. Mean follow-up was 22.5 weeks (range 8-209). At last follow-up, 40% were orthotropic with surgical success rate of 74%. Abnormal head posture reduced to <5 degrees in 82%. Reduced overshoots were in 71% and 44% of these disappeared completely. Reoperation was needed for 19% because of residual exotropia and overshoots. All were type 3 with larger preoperative exotropia (mean 34PD). The authors conclude good outcomes generally but surgery must be decided on individual characteristics.

Surgical outcomes of exotropic Duane’s retraction syndrome from a tertiary eye care center.
Sheth J, Ezisi CN, Tibrewal S, et al.
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Fiona Rowe (Prof)

Institute of Population Health, University of Liverpool, UK.

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