Unilateral recession and resection in Duane syndrome

Purpose: To assess the efficacy of lateral rectus resection with medial rec tus recession in the affected eye of patients with Duane retraction syndrom e (DRS) with esotropia and limited abduction, compared with bilateral media l rectus recessions. Methods: The charts of 9 patients with DRS who underwe nt a recession-resection procedure and 10 patients with DRS who underwent b ilateral medial rectus recessions were reviewed. Ocular ductions (graded fr om 0 = full duction to -4 = total deficit), severity of retraction, alignme nt, head position, and binocular single vision field (for study group only) were recorded before and after surgery. Results: Before surgery, the study and control groups did not differ in mean primary position esotropia (16.9 and 18.8 PD, respectively), face turn (16.5 degrees and 15.0 degrees, resp ectively), average limitation of abduction (-3.9 and -3.7, respectively), o r adduction (-0.1 and -0.3, respectively). After surgery, both groups had s imilar mean face turns (3.9 degrees and 1.0 degrees), esotropia (3.3 PD and 1.0 PD), and abduction limitation in the affected eye (-2.4 and -2.6). How ever, mean adduction was significantly worse in the control group than in t he study group (-1.5 vs -0.6, P=.02). Globe retraction improved in all cont rol subjects. It worsened in 5 study subjects and did not improve in the ot her 4. In the study group, 1 patient required reoperation for undercorrecti on and an other was overcorrected. Conclusion: Seven of 9 patients with DRS , selected on the basis of esotropia, limited abduction, and mild retractio n, benefited from a recession-resection procedure. Abduction improved to th e same degree as seen after bilateral medial rectus recessions, with less t endency to limit adduction.