title: Visual performance after congenital nystagmus surgery using extended hang back recession of the four horizontal rectus muscles.
abstract: OBJECTIVE
  To evaluate the results of surgical correction of congenital nystagmus based on the use of extensive recessions of the four horizontal rectus muscles. The outcome of this procedure in terms of visual performance of the patients has been analyzed in follow-ups of at least 1 year.
  
  
  METHODS
  Surgery was performed on 42 patients. An extended retroequatorial recession of the four horizontal rectus muscles was performed between 13 and 15 mm from the muscle insertion with hang back sutures in every case. Preoperatively, all cases showed either a horizontal pendular (4 cases) or jerk nystagmus (38 cases).
  
  
  RESULTS
  After surgery, all cases showed full preservation of ductions in all gaze positions. Torticollis decreased in all cases. Binocular best-corrected vision improved in 19 (45.2%) patients and in the remaining 23 (54.8%) it remained unchanged. Consecutive exotropia was observed postoperatively in 7 patients. A second surgical procedure was performed in 9 cases (21.4%) and a botulinum injection in 3 cases (7%). All cases of diplopia resolved. Patient satisfaction was high in 38 cases (96%).
  
  
  CONCLUSIONS
  Extended recession of horizontal rectus muscles using hang back sutures offers a good option for the surgical correction of sensorial and neuromuscular nystagmus, providing improvement in binocular best-corrected vision in 45% of the patients (21.4% more than 0.2 logMar units), a high satisfaction rate, and few associated complications. In patients with low vision this can be considered a success that may improve quality of life.
authors.affiliation: Department of Pediatric Ophthalmology and Strabismus, Ophthalmologic Institute of Alicante, Miguel Hernandez University, Alicante, Spain. jlalio@oftalio.com
authors.forename: J L
authors.initials: JL
authors.lastname: Alió
authors.forename: E
authors.initials: E
authors.lastname: Chipont
authors.forename: E
authors.initials: E
authors.lastname: Mulet
authors.forename: F
authors.initials: F
authors.lastname: De La Hoz
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004172:Diplopia / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020417:Nystagmus, Congenital / Q000503:physiopathology / Q000601:surgery*; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D012086:Reoperation; D014103:Torticollis / Q000503:physiopathology; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*