PURPOSE: To evaluate clinical properties and surgical outcomes of Duan retraction syndrome (DRS). METHODS: Twenty-one patients with DRS were evaluated. Surgery was indicated for correction of strabismus, abnormal head position, upshoot-downshoot, and globe retraction. Six patients had undergone surgery. In 5 cases, the lateral rectus muscle was recessed from 4.0 to 7.0 mm combined with Y-splitting retraction. In case of significantly positive forced duction test on the medial rectus muscle intraoperatively, simultaneous recession of the ipsilateral medial rectus muscle was performed in addition to lateral rectus surgery. RESULTS: Type I DRS was diagnosed in 83.33% of cases. All 6 cases that underwent surgery had type I DRS. After surgery, all patients showed elimination of upshoot-downshoot. Two cases had minimally improved abduction from the midline. Case 1 underwent a second operation and it was observed that the middle split part disappeared and muscular fibers proliferated to the original insertion. To protect against refusion of the middle split part of the muscle due to proliferation, nonabsorbable separation sutures were placed around the split parts of the upper and lower halves without scleral fixation. Separation sutures were placed on both parts of the muscle to protect refusion in the other cases. CONCLUSION: Y-splitting combined with recession of one or both horizontal recti is an effective procedure in patients with DRS and associated horizontal deviation. Prophylactic separation sutures as part of Y-splitting may protect against recurrence.
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