Duane retraction syndrome: Clinical features and differential diagnosis

Yıl 2011, Cilt: 38 Sayı: 2, 143 - 147, 01.06.2011

Seydi Okumuş İbrahim Erbağcı Ayşegül Çömez Ferhat Zorlu Esra Akdemir

https://doi.org/10.5798/diclemedj.0921.2011.02.0004

Cited By: 1

Öz

Objective: To determine the clinical properties of Duane\'s Retraction Syndrome (DRS) cases in our clinic, to em­phasize the importance of differential diagnosis in these patients. Materials and methods: Gender distribution, laterality, type of the syndrome, amblyopia, and accompanying ocular and non-ocular abnormalities of the 32 cases that were diagnosed as Duane\'s retraction syndrome were retrospectively investigated. Results: Thirty-two cases with average age of 7.40±3.34 were followed for 14±5.20 months at average. Twenty (62.5%) of the 32 cases of were female and 12 were male (37.5%). Twenty-seven of the cases (84.7%) were type-I, 4 was type-II (12.5%), and 1 was type-III (3.12%) DRS. Twenty-five (78.1%) of the cases had one eye involve­ment and 7 (21.9%) had two eyes involvement. Left eye involvement among cases with one eye DRS were higher (56.2%). In type-I DRS cases the rates of exotropia, am­blyopia, up-shoot and down-shoot, and abnormal head posture were as follows 43.75%, 28%, 34.37%, 37.20%, respectively. Patients who were applied Magnetic Reso­nance Imaging techniques had no abnormality about in­tracranial structure. Five among type-I DRS cases who had serious abnormal head posture had medial rectus recession operation. Conclusion: The majority of Duane retraction syndrome cases were constituted of Type I cases. It was observed that the syndrome was more frequent in women and left eye was more affected. While visual acuity was observed as normal in majority of cases, in some cases exotropia, amblyopia, and abnormal head posture were present. Significant improvements were observed in terms of slip­page angles and head postures of 5 cases with type 1 DRS after surgery.

Anahtar Kelimeler

Duane retraction syndrome, abnormal head posture, magnetic resonanceimaging.

Duane retraksiyon sendromu: Klinik özellikler ve ayırıcı tanı

Öz

Amaç: Kliniğimizde takip ettiğimiz Duane retraksiyon sendromlu (DRS) olguların klinik özelliklerini belirlemek, bu olgularda ayırıcı tanının önemini vurgulamak. Gereç ve yöntem: Duane retraksiyon sendromu tanısı almış 32 olgunun cinsiyet dağılımı, lateralite, sendromun tipi, ambliyopi varlığı, eşlik eden göz içi ve göz dışı anor­mallikleri geriye dönük olarak incelendi. Bulgular: Yaş ortalamaları 7.40±3.3 yıl olan 32 DRS\'li olgu ortalama 14±5.2 ay süreyle takip edilmişti. Olguların 20\'si (%62.5) kadın, 12\'si (%37.5) erkekti. Olgularımızın 27\'si (%84.4) Tip 1, 4\'ü (%12.5) Tip 2 ve biri (%3.1) Tip III DRS idi. Olgularımızın 25\'inde (%78.1) tek göz tutulumu, 7\'sinde (%21.9) iki göz tutulumu mevcuttu. Tek gözünde DRS olan olgularda sol gözde daha fazla tutulum mev­cuttu (%56.2). Tip 1 DRS\'li olgularda ezotropya (%51.9), ambliyopi (%28), up-shoot ve down-shoot (%34.4), anor­mal baş pozisyonu (%37.2) oranında gözlenmekteydi. Manyetik Rezonans Görüntüleme (MR) yapılan olgular­da kafa içi bir patolojiye rastlanmadı. Ciddi anormal baş pozisyonu(ABP) bulunan Tip 1 DRS\'li 5 olguda iç rektusa geriletme operasyonu yapıldı. Sonuç: Duane retraksiyon sendromlu olguların çoğun­luğunu Tip 1 DRS\'li olgular oluşturmaktaydı. Sendromun kadınlarda daha çok görüldüğü ve sol gözü daha fazla etkilediği izlendi. Olguların büyük çoğunluğunda görme keskinliği normal izlenirken, bazı olgularda ezotropya, ambliyopi, anormal baş pozisyonu mevcuttu. Kayması ve anormal baş pozisyonu mevcut olan 5 tip 1 DRS\'li olgu­nun ameliyat sonrası kayma açıları ve baş pozisyonların­da belirgin düzelme izlendi.

Anahtar Kelimeler

Duane retraksiyon sendromu, anor­mal baş pozisyonu, manyetik rezonans görüntüleme.

Kaynakça

• Duane A. Congenital deficiency of abduction, associated with impairment of adduction, retraction movements, con- traction of the palpebral fissure and oblique movements of the eye.1905. Arch Ophthalmol 1996; 114(10):1255-7.
• Saad N, Lee J. Medial rectus electromyographic abnormali- ties in Duane syndrome. J Pediatr Ophthalmol Strabismus 1993;30(2):88–91.
• Zhang F. Clinical features of 201 cases with Duane’s retrac- tion syndrome. Chin Med J (Engl). 1997;110(10):789–91.
• Parsa CF, Grant E, Dillon Wp Jr. et al. Absence of the ab- ducens nerve in Duane Syndrome verified by magnetic res- onance imaging. Am J Ophthalmol 1998;125(3):399-401.
• Huber A. Electrophysiology of the retraction syndromes. Br J Ophthalmol 1974;58(3):293-300.
• Mehel E, Quere Ma, Lavenant F, Pechereau A. Epidemiolog- ical and clinical aspects of stilling-Turk- Duane Syndrome. J Fr Ophthalmol 1996;19(8):533-42.
• Erkan ND, Berk T, Şener EC, Sanaç AŞ. Duane retraksi- yon sendromunun cerrahi tedavisi. T Klin Oftalmoloji 1994;3(3):161–65.
• Bernasconi OR, Klaunguti G,Presset C. Stilling-Duane re- traction syndrome; surgical options. Klin Monatsbl Augen- heildkd 1995;206(5):351-5.
• Rimmer S, Katz B. Dissociated vertical deviation in a patient with Duane’s retraction syndrome. J Clin Neuro-Ophthal- mol 1990; 10(1):38-40.
• 10-Shiratori A, Kameyama C, Sibasaki K. Adduction defi- ciency following a large medial rectus recession in Duane’s retraction syndrome type I. J Pediatr Ophthalmol Strabis- mus 1999; 6(2):98–100.
• Kadayıfçılar S, Aydın P, Oto S. A case of Duane’s retraction syndrome with multiple congenital malformations. Eur J Ophthalmol 1997;7(2):193-5.
• Brodsky MC, Boop FA. Forth ventricular ependymoma in child with Duane retraction syndrome. Pediatr Neurosurg 1997; 26(3):157-9.
• Multern M, Keohane C, O’conner G. Bilateral abducens nerve lesions in unilateral type 3 Duane retraction syn- drome. Br J Ophthalmol 1994; 78(79):588-91.
• Ott S, Borchert M, Chung M at al. Exclusion of candidate genetic loci for Duane retraction syndrome. Am J Ophthal- mol 1999; 127(3):358-60.
• von Norden GK, Campos EC. Special forms of strabismus. In: von Norden GK, Campos EC, eds. Binocular Vision and Ocular Motility. 6 th ed. Mosby, Inc;2002:458-66.
• Pressman SH, Scott WE. Surgical treatment of Duane’s syn- drome. Ophthalmology 1986;93(1):29–38.
• Britt MT, Velez FG, Velez G, Rosenbaum AL. Vertical rec- tus muscle transposition for bilateral Duane syndrome. J AAPOS 2005;9(5):416–21.
• Rao VB, Helveston EM, Sahare P. Treatment of upshoot and downshoot in Duane syndrome by recession and Y-splitting of the lateral rectus muscle. J AAPOS 2003 ;7(6):389–95.
• Maino DM, Scharre JE. Poland-Möbius syndrome: a case report. Optom Vis Sci. 1989 ;66(9):621–5.
• Kavaklı S, Atilla H, Erkam N. Konjenital ezotropyada klinik özellikler. MN-Oftalmoloji Dergisi 2000;7(1):70–5.