title: Kestenbaum procedure with posterior fixation suture for anomalous head posture in infantile nystagmus.
abstract: BACKGROUND
  The purpose of this study was to report the effect of combining the Kestenbaum procedure with posterior fixation suture for infantile horizontal nystagmus with anomalous head posture (AHP) in children.
  
  
  METHODS
  Nine consecutive patients who underwent combined Kestenbaum procedure plus posterior fixation suture to the recessed muscles at the same time were retrospectively studied. All patients were orthotropic before surgery and were followed for at least 6 months. Pre- and postoperative AHP and binocular corrected visual acuity (BCVA), and ocular alignment were assessed.
  
  
  RESULTS
  Mean age at surgery was 4.8 +/- 1.5 years. The average follow-up was 29.7 months. The average head turn preoperatively was 27.4 degrees and postoperatively 7.2 degrees . The average net change in AHP was 24.8 degrees (P = 0.008). Seven of 9 patients (78%) achieved a residual head turn of 10 degrees or less. The average Log Mar BCVA was 0.33 preoperatively and 0.31 postoperatively (P = 0.68). Only 1 patient needed additional surgery for residual horizontal AHP. No patient developed strabismus.
  
  
  CONCLUSIONS
  Combined Kestenbaum procedure with posterior fixation suture was an effective and stable procedure in reducing AHP of the range of 20 degrees to 35 degrees in children with infantile nystagmus.
authors.affiliation: Department of Ophthalmology & Visual Science, Holy Family Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. nyeokang@hanmail.net
authors.forename: Nam Yeo
authors.initials: NY
authors.lastname: Kang
authors.forename: Sherwin J
authors.initials: SJ
authors.lastname: Isenberg
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006257:Head; D006801:Humans; D008297:Male; D009759:Nystagmus, Pathologic / Q000503:physiopathology* / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods* / Q000592:standards; D011187:Posture; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D014792:Visual Acuity