title: The efficacy of asymmetric bilateral medial rectus muscle recession surgery in unilateral, esotropic, type 1 Duane syndrome.
abstract: BACKGROUND
  Many patients with esotropic, type 1 Duane syndrome adopt a head turn to gain binocular vision. Numerous surgical procedures have been performed to correct this condition, including asymmetric bilateral medial rectus muscle recession, first proposed by Jampolsky. However, few publications reported on the efficacy of this procedure.
  
  
  METHODS
  The medical records of patients with unilateral, esotropic Duane syndrome who had asymmetric medial rectus muscle recession for correction of their abnormal head turn were retrospectively reviewed with attention to head turn, ductions, and motor alignment at near and distance fixation. Surgery was considered successful when preoperative head turn was completely eliminated.
  
  
  RESULTS
  A total of 28 patients (18 females; mean age, 8 years) were included. In 24 patients (86%), the left eye was involved. Medial rectus recession averaged 4.7 mm (range, 3.25-6.0 mm) in the affected eye, with a recession larger by 1.0 mm in the unaffected eye. Average esotropia in the forced primary position improved from 32(Δ) preoperatively to 6(Δ) postoperatively, with a mean 22° improvement in head position (24°-2°). Twenty-four patients (86%) achieved complete resolution of their head turn postoperatively; the other 4 patients experienced partial improvement, with a residual head turn of 10°; a second re-recession of the medial rectus muscle in the affected eye of 1 patient resulted in complete resolution of head turn.
  
  
  CONCLUSIONS
  Our study showed that asymmetric bilateral medial rectus recession eliminated the head turn in most of our patients with unilateral esotropic Duane syndrome.
authors.affiliation: Department of Ophthalmology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. gaddotan@hotmail.com
authors.forename: Gad
authors.initials: G
authors.lastname: Dotan
authors.forename: Ainat
authors.initials: A
authors.lastname: Klein
authors.forename: Noa
authors.initials: N
authors.lastname: Ela-Dalman
authors.forename: Shiri
authors.initials: S
authors.lastname: Shulman
authors.forename: Chaim
authors.initials: C
authors.lastname: Stolovitch
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004370:Duane Retraction Syndrome / Q000503:physiopathology / Q000601:surgery*; D004948:Esotropia / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D019416:Head Movements; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology; D055815:Young Adult