PURPOSE: To compare the results of two surgical procedures in the management of vertical
shooting in exotropic Duane retraction syndrome (XT-DRS).
METHODS: This was a prospective, interventional study of consecutive XT-DRS patients with
vertical shooting on adduction operated on from August 2012 to January 2015. 25 patients
were identified and were divided into two groups: Y-split (Y) group, which included 12 patients,
who underwent Y splitting with recession of the lateral rectus muscle (LR); and isolated
recession (R) group, which included 13 patients, who underwent isolated LR recession. Surgical
outcomes in both groups were compared in terms of improvements in vertical shoots, ocular
deviation and face turn.
RESULTS: Upshoot, downshoot, XT and face turn showed significant postoperative
improvement in both groups (p< 0.001). When comparing both groups, the difference in the
average correction of the upshoot and downshoot was statistically significant (p=0.0004 and
0.0174 respectively) in benefit of the Y-group. One case of horizontal overcorrection
(consecutive esotropia) with another case of horizontal undercorrection (persistent XT) were
reported postoperatively in the Y-group.
CONCLUSION: in our series, both procedures achieved comparable results in the correction of
XT and face turn. The combined Y-split recession procedure attained a more significant
improvement of upshoot and downshoot but with higher incidence of postoperative
complications.