Surgical management of bilateral esotropic Duane syndrome

PurposeTo describe the indications and outcomes of surgery for bilateral esotropic Duane syndrome.MethodsThe medical records of consecutive patients with bilateral esotropic Duane syndrome who underwent surgery from January 1999 to December 2008 were retrospectively reviewed. Data for surgical indications and outcomes were analyzed. Success was defined as postoperative orthotropia with eso- or exodeviation <8Δ.ResultsA total of 14 patients with esotropic bilateral Duane Syndrome underwent surgery: 12 had bilateral medial rectus muscle recession; 1 had unilateral medial rectus muscle recession; and 1 had bilateral asymmetrical medial rectus and lateral rectus muscle recessions. The mean preoperative esodeviation was 38.14Δ ± 13.24Δ, (range, 14Δ-70Δ). The mean medial rectus recession was 5.7 mm in the right eye and 5.5 mm in the left eye. The mean follow-up period was 11.7 months (range, 3-37 months). Success was achieved in 12 of 14 patients (85.71%); 2 patients had a residual esotropia of 15Δ. In all patients who underwent surgery, there was satisfactory improvement in associated globe retraction and head turn. None of the patients developed consecutive exodeviation.ConclusionsBilateral medial rectus muscle recession can provide a good outcome for patients with bilateral esotropic Duane syndrome. The mean amount of medial rectus muscle recession required may be greater than what is generally recommended for similar sized esodeviations in patients with infantile esotropia.