Elsevier

Ophthalmology

Volume 112, Issue 1, January 2005, Pages 109-113
Ophthalmology

Original article
Presence of the abducens nerve according to the type of Duane's retraction syndrome

https://doi.org/10.1016/j.ophtha.2004.06.040Get rights and content

Objective

To analyze whether the presence of the abducens nerve might depend upon the type of Duane's retraction syndrome (DRS).

Design

Observational case series.

Participants

Sixteen patients with type 1 DRS, 2 patients with type 2 DRS, and 5 patients with type 3 DRS.

Methods

Ophthalmologic examination and thin-sectioned magnetic resonance imaging (MRI) at the brain stem level were performed in 23 DRS patients. To confirm the accuracy of the procedure, we compared the results obtained with those of a control group of 30 individuals using the same technique.

Main outcome measures

Examination of ductions and versions and the presence of the abducens nerve on MRI.

Results

The abducens nerve on the affected side could not be observed using MRI in 18 (100%) of 18 eyes (16 patients) with type 1 DRS and in 3 of 5 eyes with type 3 DRS. Conversely, the abducens nerve was observed in 2 of 2 eyes with type 2 DRS and 2 of 5 eyes with type 3 DRS. The abducens nerve was observed in 60 (100%) of 60 eyes screened as controls.

Conclusions

The abducens nerve on the affected side was absent in type 1 DRS patients and some type 3 DRS patients, but present in type 2 DRS patients as well as in some type 3 DRS patients. In terms of the presence or absence of the abducens nerve, type 1 and type 2 DRS were homogenous, and type 3 DRS was heterogenous.

Section snippets

Materials and methods

Twenty-one patients with the characteristic findings of DRS, such as abduction deficit or adduction deficit, upshoot, downshoot, fissure narrowing on adduction, and 2 patients (4 and 6 years old) with an abduction deficit and a mild degree of upshoot, downshoot, or fissure narrowing on adduction were recruited from March 2003 to March 2004. Sixteen patients with type 1 DRS, 2 patients with type 2 DRS, and 5 patients with type 3 DRS, based on Huber's classification,6 were prospectively included

Results

The abducens nerve on the affected side could not be observed using MRI in 18 (100%) of 18 eyes (16 patients) with type 1 DRS (Fig 1) and in 3 (60%) of 5 eyes (5 patients) with type 3 DRS. The abducens nerve on the affected side was observed in 2 (100%) of 2 eyes (2 patients) with type 2 DRS (Fig 2) and 2 (40%) of 5 eyes (5 patients) with type 3 DRS (Fig 3). Among the 5 abducens nerves visible on the affected side, 4 had a normal root exit from the pontomedullary junction, whereas 1 emerged

Discussion

This report describes the varying presence of the abducens nerve according to the type of DRS. In type 1 DRS, the abducens nerve was absent in all patients. Conversely, in type 2 DRS, the abducens nerve was present in all patients. In type 3 DRS, the abducens nerve was absent or present. Though the numbers of type 2 and type 3 patients were small, they are reasonable, considering the rarities of types 2 and 3 DRS. Moreover, because 100% accuracy was achieved in the control group, we believe our

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Manuscript no. 240297.

The authors have no financial interest regarding the subject matter in this article.

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