Surgery for the treatment of vertical head posturing associated with infantile nystagmus syndrome: results in 24 patients.
BACKGROUND
The study of the clinical and electrophysiological effects of eye muscle surgery on patients with infantile nystagmus has broadened our knowledge of the disease and its interventions.


METHODS
Prospective, comparative, interventional case series.


METHODS
Twenty-four patients with a vertical head posture because of electrophysiologically diagnosed infantile nystagmus syndrome. The ages ranged from 2.5 to 38 years and follow up averaged 14.0 months.


METHODS
Thirteen patients with a chin-down posture had a bilateral superior rectus recession, inferior oblique myectomy and a horizontal rectus recession or tenotomy. Those 11 with a chin-up posture had a bilateral superior oblique tenectomy, inferior rectus recession and a horizontal rectus recession or tenotomy.


METHODS
Outcome measures included: demography, eye/systemic conditions and preoperative and postoperative; binocular, best optically corrected, null zone acuity, head posture, null zone foveation time and nystagmus waveform changes.


RESULTS
Associated conditions were strabismus in 66%, ametropia in 96%, amblyopia in 46% and optic nerve, foveal dysplasia or albinism in 54%. Null zone acuity increased at least 0.1 logMAR in 20 patients (P < 0.05 group mean change). Patients had significant (P < 0.05) improvements in degrees of head posture, average foveation time in milliseconds and infantile nystagmus syndrome waveform improvements.


CONCLUSIONS
This study illustrates a successful surgical approach to treatment and provides expectations of ocular motor and visual results after vertical head posture surgery because of an eccentric gaze null in patients with infantile nystagmus syndrome.
Hertle
Richard W
RW
Children's Hospital Medical Center of Akron and SUMMA Medical Center, Akron, Ohio, USA. rslpshot@aol.com
Yang
Dongsheng
D
Adams
Kenneth
K
Caterino
Roxanne
R
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005133:Eye Movements; D006257:Head; D006801:Humans; D020417:Nystagmus, Congenital / Q000503:physiopathology / Q000601:surgery*; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D011187:Posture; D011446:Prospective Studies; D058971:Tenotomy; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult