Abuzer GUNDUZ, Suheda DUMAN, Selim DOGANAY

Baş pozisyonu ile birlikte yukarı vuruşu olan duane tip i olgusuna cerrahi yaklaşım: olgu sunumu

On üç yaşında bayan hasta, 6 aylıktan beri sol gözde kayma şikâyeti varmış. Muayenesinde düzeltmeli görme keskinliği snellen eşeline göre sağ gözde tam (10/10), sol gözde 0.5 (5/10) saptandı. Biomikroskopi ve fundus muayenesi doğal olarak değerlendirildi. Skloplejik refraksiyon sağ gözde +1.0 (+0.5*80), sol gözde +3.75 (+1.0*110) dioptri (D) idi. Yapılan şaşılık muayenesinde; Sola dönük yüz pozisyonu (20 derece) mevcut. Sol gözde abdüksiyonda kısıtlılık (-4) ile abdüksiyonda kapak aralığında hafif genişleme mevcuttu. Ayrıca addüksiyonda yukarı vuruş (upshoot) ve addüksiyonda kapak aralığında daralma tespit edildi. Bu bulgularla yukarı vuruşlu Duane Tip I tanısı kondu. Hastaya cerrahi planlandı. Yapılan cerrahide lateral rektusa (LR) geriletme ile kombine Y-split prosedürü, medial rektusa (MR) ise geriletme yapıldı. Ameliyat sonrası 1. gün, 1. ay ve 6. ay da kontrolleri yapıldı. 6. Aydaki kontrolünde hastanın ameliyat öncesine göre sol yüz dönüklüğü düzelmiş. Sol göz addüksiyon da oluşan yukarı vuruşun kaybolduğu saptandı.

Surgical approach to type i duane syndrome together with head position and upshoot: a case report

A 13-year-old girl was told by her parents to have had strabismus since she was 6months-old. Her corrected visual acuity was 20/20 in the right eye and 20/63 in the left eye. Anterior segment and fundus examinations were normal. Cycloplegic refraction was +1,0 (+0.5*80) in the right and +3.75 (+1.0*110) in the left. She had a 20° leftward face turn. Tests showed that her left eye had limitation of abduction, retraction of the globe, narrowing of palpebral fissure, and upshoot on attempted adduction. The patient underwent recession of the left medial rectus muscle and lateral rectus muscle recession of 7.0 mm with Y-splitting. On postoperative first day and after one month and then six months, the patient was checked for follow-ups. In the follow-up after 6 months, head turn and upshoot were found to be eliminated.

PDF

___

1. Duane A. Congenital deficiency of abduction, associated with impairment of adduction, retraction movements, contraction of the palpebral fissure, and oblique movements of the eye. Arch Ophthalmol 1996;114(10):1255-6.
2. Derespinis PA, Caputo AR, Wagner RS, Guo S. Duane's retraction syndrome. Surv Ophthalmol 1993;38(3):257-8.
3. Von Noorden GK, Murray E. Up and down shoots in Duane's retraction syndrome. J Pediatr Ophthalmol Strabismus 1986;23(5):212-5.
4. Kraft SP. A surgical approach for Duane's syndrome. J Pediatr Ophthalmol Strabismus 1988;25(3):119-30.
5. Mitchell PR, Parks MM. Ophthalmoplegic syndromes and trauma. In: Duane TD, ed. Clinical ophthalmology. Philadelphia: Harper and Row 1982;1:20.
6. Magoon E, Cruciger M, Scott AB, Jampolsky A. Diagnostic injection of xylocaine into extraocular muscles. Ophthalmol 1982;89(5):489-1.
7. Mohan K, Saroha V. Vertical rectus recession for the innervational upshoot and downshoot in Duane's retraction syndrome. J Pediatr Ophthalmol Strabismus 2002;39(3):191.
8. Von Noorden GK. Recession of both horizontal recti muscles in Duane's retraction syndrome with elevation and depression of the adducted eye. Am J Ophthalmol 1992;114:(3)311-3.
9. Sprunger DT. Recession of both horizontal rectus muscles in Duane's syndrome with globe retraction in primary position. J Pediatr Ophthalmol Strabismus 1997;1(1):31-3.
10. Venkateshwar BR, Eugene MH, Prashant S. Treatment Of Upshoot and Downshoot in Duane Syndrome by Recession and Ysplitting of the Lateral Rectus Muscle. J AAPOS 2003;7(6):389-5.
11. Rogers GL, Bremmer DL. Surgical treatment of the upshoot and downshoot in Duane's retraction syndrome. Ophthalmol 1984;91(11):1380-3.