The outcomes are reported of muscle belly union technique with medial rectus recession for cases with restriction according to the results of intraoperative forced duction testing (FDT). Surgery involved isolation of the lateral and superior recti muscles, which were separated, and 5.0 non-absorbable mersilene sutures passed through half of each muscle belly in the range of 12-15mm posterior to the insertion site. Then both arms of each suture were tied together in two separate pairs. Medial rectus recession was according to the preoperative angle of esotropia and based on the FDT. The study included 24 eyes of 16 patients; eight males and mean age of 53.08±10.64 years. Mean axial length was 31.49±1.86mm and mean refractive error was -18.06±4,21D. Mean preoperative esotropia was 93.71±23.1PD and hypertropia of 9.33 ±6.88PD. All patients had a positive FDT with medial rectus recession of 6-9mm. At final follow-up esotropia reduced to 11.53±15.59PD and all vertical deviations resolved. Limited abduction reduced from a mean of -3.1±1.83 to -0.95±0.68. There were no over corrections and no further surgical procedures. The authors conclude their modification to the Yokayama procedure has favourable outcomes and reduces the need for further procedures to achieve alignment.