Comparative Study of Recession with Y- splitting Vs Recession Only of Lateral Rectus Muscle Surgery for up/down Shoot in Duane Retraction Syndrome

Abstract

Purpose: To evaluate and compare the effectiveness of lateral rectus muscle recession with Y-splitting versus recession only in the surgical treatment of up/down shoot in Duane retraction syndrome patients. Material and Methods: In this prospective study, 42 patients of Duane retraction syndrome with up/down shoot underwent surgery over a period of seven years, were divided into two groups of twenty one each.  In group A, Y-splitting of lateral rectus with recession and in group B, only lateral rectus recession was performed. In all the patients width of lateral rectus muscle at its insertion was measured. Postoperative results were compared and analyzed in terms of up/down shoot on adduction. Data analysis was performed using R Core Team (2020) R., and the P value <0.05 was taken as significant. Results: The Mean age at the time of surgery was 12.5 ± 4.5 years in group A, and 11.5 ± 3.9 years in group B (range, 5 to 22 years). Correction of up/down shoot was 100% in group A and 81% in group B. Five patients in group B showed no improvement of up/down shoot in whom the width of lateral rectus was 7mm or less and the surgery was recession of lateral rectus only. In these 5 patients, Y-splitting of lateral rectus was done in second sitting with good result Mean follow up was 12 months (range, 3 weeks to 3 years). Conclusions: Recession of lateral rectus muscle with Y-splitting is  more effective (100%) when compared to recession only, in correcting significant up/down shoot in Duane retraction syndrome. Lateral rectus muscle Y- splitting is not necessary in these patients with upshoot / down shoot if the width of the muscle at insertion is within normal limits (8.3 -12.5 mm). In these cases simple recession is enough. Lateral rectus muscle Y splitting is essential when the width of lateral rectus muscle at insertion is 7mm or less.