Results of bilateral medial rectus muscle recession in unilateral esotropic Duane syndrome

PURPOSE To report the results of bilateral medial rectus muscle recession in improvement of the ocular alignment and motility of patients with unilateral esotropic Duane syndrome. METHODS All medical files of patients with Duane syndrome seen by the first author between 1997 and 2006 were reviewed. Pre- and postsurgical deviation, angle of abnormal head position, severity of limitation in abduction, severity of globe retraction, and upshoots and downshoots were compared. RESULTS Twenty-five patients with unilateral esotropic Duane syndrome (type 1) underwent recession of both medial rectus muscles. Mean age of patients was 9.7 years: male-to-female ratio was 0.67 (10:15). The left eye was involved in 23 of the patients. Mean esotropia decreased from 24.3(Delta) (range, 12(Delta)-50(Delta)) to 1.3(Delta) (range, 0(Delta)-10(Delta)). Mean abnormal head position decreased from 21.4(Delta) (range, 15 degrees-35 degrees) to 1 degrees (range, 0 degrees-5 degrees). Esotropia and abnormal head position disappeared in 80% of the patients and improved in the remaining. None of the patients developed exotropia. Mean limitation in abduction decreased from -3.8 to -3.3. Globe retraction was eliminated in 14 of the patients and improved in the others. Mild upshoots and downshoots, which were observed in 5 patients, disappeared in 2 and improved in 3 patients. CONCLUSIONS Bilateral recession of medial rectus muscles has resulted in improvement of deviation, abnormal head position, and globe retraction in patients with unilateral esotropic Duane syndrome. (J AAPOS 2009;13:339-342)