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Duane vertical surgical treatment
Tratamiento del síndrome de Duane vertical
M.L. Merino
, P. Gómez de Liaño, P. Merino, G. Franco
Corresponding author
Sección de Motilidad Ocular, Departamento de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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"apellidos" => "Franco" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Sección de Motilidad Ocular, Departamento de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento del síndrome de Duane vertical" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0030" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 305 "Ancho" => 901 "Tamanyo" => 56023 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Third case after suprainsertion of both lateral rectus and posterior tenectomy of superior obliques.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The Duane syndrome (DS) is a restricted condition characterized by limited horizontal duction with ocular globe retraction and diminished palpebral fissure. Additional signs which may arise include a generally small horizontal deviation, ocular torticollis and vertical overaction when attempting abduction, also known as upshoots when the direction is upward or downshoots when the direction is downward.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The most standardized classification is that proposed by Huber,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> which describes three types of DS. There is a fourth variant known as the Y-Duane syndrome, Duane syndrome type IV, Kushner syndrome<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> or Papst syndrome.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The condition consists in orthotropia or moderate exotropia in primary gaze position (PGP) showing in supraversion a large vertical incomitance between 45 and 90 prismatic diopters (Pd).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Clinical cases</span><p id="par0020" class="elsevierStylePara elsevierViewall">Description of three healthy patients aged 5, 6 and 9, referred due to divergent strabismus in all cases and with intermittent diplopia in the third. Initial visual acuity (VA) in the three cases was of one in both eyes (BE), with binocularity, TNO being of 120″, 60″ and 60″, respectively.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The first patient exhibited exotropia of 6 Pd in PGP with Y-shaped incomitance of 50 Pd, upshoot and diminished palpebral fissure in adduction (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Suprainsertion of both lateral rectus muscles was performed, one insertion and median into original, with asymmetric recession thereof measuring 3 and 4<span class="elsevierStyleHsp" style=""></span>mm in RE and LE, respectively. The post-surgery result was satisfactory with orthotropia in PGP, correction of vertical phenomenon and slight residual divergence upon supraversion (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The second patient exhibited 14 Pd exotropia in PGP, with 50 Pd incomitance in Y. in addition, he associated pseudohyperfunction of inferior obliques, diminished palpebral fissure in abduction, torticollis with chin upward and limitation of RE abduction. Suprainsertion of both lateral rectus was performed, one insertion and median into original added to recession thereof measuring 6.5<span class="elsevierStyleHsp" style=""></span>mm RE and 1<span class="elsevierStyleHsp" style=""></span>mm LE. The post-surgery period attained orthotropia in PGP with absence of torticollis and H syndrome (<a class="elsevierStyleCrossRefs" href="#fig0015">Figs. 3 and 4</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The third case exhibited Y-shaped incomitance of 50 Pd, with orthotropia in PGP and chin upwards torticollis. Upon infraversion, the patient exhibited 12 Pd exotropia reaching up to 20 Pd in extreme positions. In addition, pseudohyperfunction of inferior and superior obliques (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). Surgery consisted in suprainsertion of both lateral rectus, one insertion and median to the original. However, a −30 Pd Lambda syndrome upon infraversion was obtained. In a second time, posterior tenectomy of superior obliques was performed, 8<span class="elsevierStyleHsp" style=""></span>mm RE and 9<span class="elsevierStyleHsp" style=""></span>mm LE. The result changed only slightly as the patient maintained orthophoria in PGP and with supraversion, divergence with infraversion, maintaining binocularity and absence of diplopia (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>).</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">In our experience, surgical treatment of Y-shaped DS improves vertical incomitance with the subsistence in most cases of residual alterations. Out of the three cases, satisfactory results were obtained in two as in the third the deviation was inverted due to the appearance of divergence in infraversion. Possibly, in this case the technique of choice would have been splitting instead of superior transposition of lateral rectus,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">4</span></a> due to the existence of pseudohyperfunction of the four oblique muscles. The possibility of not carrying out surgery was not considered as the girl exhibited torticollis with the chin upwards and in addition exhibited manifested diplopia as soon as she carried out the supraversion movements.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Campomanes<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">5</span></a> published similar results in a series of 11 cases in which he performed recession of both lateral rectus at the equator with superior transposition, midway between the original insertion and that of the superior rectus, observing in all cases significant divergence reduction in supraversion with residual alteration.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In turn, Kushner<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> presented a series of nine patients weakening oblique inferior muscles in four cases without correcting Y-shaped anisotropia. However, in three patients said author carried out reversion and subprime session of lateral rectus, obtaining improved vertical incomitance.</p><p id="par0055" class="elsevierStylePara elsevierViewall">To conclude, in a condition of a large divergence in supraversion with pseudohyperaction of the four oblique muscles, orthotropia or slight exotropia, including clinical absence of enophthalmos or limitation of abduction, the presence of Y-shaped DS should be considered. Surgery consists in suprainsertion of lateral rectus, associated or not to recession thereof depending on the exhibited horizontal incomitance. In this way vertical incomitance is improved while in most cases residual alteration remains.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">No conflicts of interest have been declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres354622" "titulo" => array:3 [ 0 => "Abstract" 1 => "Case report" 2 => "Discussion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec336020" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres354621" "titulo" => array:3 [ 0 => "Resumen" 1 => "Caso clínico" 2 => "Discusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec336019" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical cases" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-12-27" "fechaAceptado" => "2012-10-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec336020" "palabras" => array:5 [ 0 => "Duane syndrome IV" 1 => "Duane syndrome" 2 => "Kushner syndrome" 3 => "Papst syndrome" 4 => "Restrictive strabismus" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec336019" "palabras" => array:5 [ 0 => "Síndrome de Duane tipo <span class="elsevierStyleSmallCaps">iv</span>" 1 => "Síndrome de Duane" 2 => "Síndrome de Kushner" 3 => "Síndrome de Papst" 4 => "Estrabismo restrictivo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Case report</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We report three cases with a vertical incomitance in upgaze, narrowing of palpebral fissure, and pseudo-overaction of both inferior oblique muscles. Surgery consisted of an elevation of both lateral rectus muscles with an asymmetrical weakening. A satisfactory result was achieved in two cases, whereas a Lambda syndrome appeared in the other case.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The surgical technique of upper-insertion with a recession of both lateral rectus muscles improved vertical incomitance in two of the three patients; however, a residual deviation remains in the majority of cases.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0025">Caso clínico</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Se describen tres casos con una incomitancia vertical en Y, disminución de la hendidura palpebral y pseudohiperfunción de oblicuos inferiores. La cirugía consistió en una suprainserción de ambos rectos laterales con debilitamiento asimétrico. El resultado fue satisfactorio en 2 casos, obteniendo en el tercero una inversión de la desviación vertical.</p> <span class="elsevierStyleSectionTitle" id="sect0030">Discusión</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">En el síndrome de Duane vertical, el debilitamiento de los rectos laterales y la transposición superior de los mismos permitió mejorar la desviación en dos de los tres pacientes tratados. Sin embargo, la corrección total de la desviación suele ser infrecuente, pudiendo quedar alteraciones residuales.</p>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Merino ML, Gómez de Liaño P, Merino P, Franco G. Tratamiento del síndrome de Duane vertical. Arch Soc Esp Oftalmol. 2014;89:170–172.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Presented at the 22nd Course of the Strabology Society of Spain, Baiona, May 13–14, 2011.</p>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 561 "Ancho" => 901 "Tamanyo" => 85028 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">First case prior to surgery.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 341 "Ancho" => 901 "Tamanyo" => 63038 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">First case after suprainsertion of both lateral rectus and asymmetric recession thereof.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 349 "Ancho" => 902 "Tamanyo" => 56664 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Second case prior to surgery.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 790 "Ancho" => 1302 "Tamanyo" => 172088 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Second case after suprainsertion of both lateral rectus and asymmetric recession thereof. Lancaster screen (A) prior to surgery, and (B) after surgery.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 558 "Ancho" => 952 "Tamanyo" => 72295 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Third case prior to surgery.</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 305 "Ancho" => 901 "Tamanyo" => 56023 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Third case after suprainsertion of both lateral rectus and posterior tenectomy of superior obliques.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pseudo inferior oblique overaction associated with Y and V patterns" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B.J. 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Eight cases including evidence of contraccion by bilateral globe retraccion in two cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Khawam" 1 => "S. Shawaf" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Binocul Vis Strabismus: Second Quart" "fecha" => "1996" "volumen" => "11" "paginaInicial" => "113" "paginaFinal" => "118" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0030" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.A. Campomanes Eguiarte" 1 => "Y. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 2 | 2 | 4 |
| 2021 January | 1 | 0 | 1 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 11 | 1 | 12 |
| 2018 January | 13 | 4 | 17 |
| 2017 December | 7 | 3 | 10 |
| 2017 November | 12 | 3 | 15 |
| 2017 October | 18 | 3 | 21 |
| 2017 September | 7 | 2 | 9 |
| 2017 August | 16 | 2 | 18 |
| 2017 July | 22 | 3 | 25 |
| 2017 June | 21 | 13 | 34 |
| 2017 May | 28 | 0 | 28 |
| 2017 April | 38 | 4 | 42 |
| 2017 March | 39 | 31 | 70 |
| 2017 February | 40 | 3 | 43 |
| 2017 January | 24 | 2 | 26 |
| 2016 December | 48 | 4 | 52 |
| 2016 November | 39 | 4 | 43 |
| 2016 October | 45 | 4 | 49 |
| 2016 September | 71 | 6 | 77 |
| 2016 August | 45 | 6 | 51 |
| 2016 July | 22 | 2 | 24 |
| 2016 June | 19 | 12 | 31 |
| 2016 May | 25 | 13 | 38 |
| 2016 April | 28 | 20 | 48 |
| 2016 March | 18 | 14 | 32 |
| 2016 February | 18 | 19 | 37 |
| 2016 January | 23 | 19 | 42 |
| 2015 December | 21 | 14 | 35 |
| 2015 November | 24 | 14 | 38 |
| 2015 October | 29 | 19 | 48 |
| 2015 September | 17 | 10 | 27 |
| 2015 August | 47 | 8 | 55 |
| 2015 July | 31 | 5 | 36 |
| 2015 June | 21 | 5 | 26 |
| 2015 May | 22 | 5 | 27 |
| 2015 April | 19 | 7 | 26 |
| 2015 March | 24 | 7 | 31 |
| 2015 February | 15 | 2 | 17 |
| 2015 January | 20 | 3 | 23 |
| 2014 December | 45 | 10 | 55 |
| 2014 November | 29 | 4 | 33 |
| 2014 October | 38 | 11 | 49 |
| 2014 September | 3 | 3 | 6 |
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