title: Kestenbaum procedure with combined muscle resection and tucking for nystagmus-related head turn.
abstract: BACKGROUND
  Literature has dealt extensively with dose-effect relations for recess-resect procedures for correction of horizontal nystagmus-related head turn. However, muscle tucking procedures have some advantages compared to resection procedures. Aim of this study was to evaluate dose-effect relations of Kestenbaum surgery with symmetrical combined recession and tucking (instead of resection) of the horizontal rectus muscles for the reduction of a nystagmus-related head turn.
  
  
  METHODS
  In a retrospective study, clinical findings of 42 patients who consecutively underwent treatment in our institution between 2000 and 2011 were investigated. The patients were aged 4-57 years (median age 6 years). For all patients, surgery aimed to correct a horizontal head turn (to the right: 18 patients) due to infantile nystagmus. The head turn was measured with a goniometer with the patient fixing the smallest age-appropriate target distinguishable for the patient.
  
  
  RESULTS
  The median absolute head turn before surgery was 30° (min. 15°, max. 45°). The four horizontal rectus muscles were recessed or tucked between 5.5 and 10 mm, median 9 mm. All four muscles were recessed or tucked for the same amount. At the first postoperative day, the median dose-effect relation was 1.88° reduction of head turn per millimeter surgery on one eye (min. 0.5°/mm, max. 3.2°/mm). The median head turn was 0° (min. -20°, max. 15°). Surgery was considered successful in 88% of the patients with a reduction of the head turn to max. 10°. Data of 36 patients were available for the long-term postoperative period (median 1.5 years; min. 6 weeks, max. 11 years). The median head turn was 10° (min. -16°, max. 30°). The median dose-effect relation was reduced to 1.35°/mm per eye (min. 0°/mm, max. 2.9°/mm). Surgery was considered successful in 72 % of the patients with a reduction of the head turn to max. 10°. Three patients showed an overcorrection with a head turn of 8°, 15° and 16° to the other side. A squint has not been induced.
  
  
  CONCLUSIONS
  The dose-effect relation for Kestenbaum surgery with symmetrical combined recession and tucking of the horizontal rectus muscles is comparable to the dose-effect relation reported by other authors for symmetrical combined recession and resection.
authors.affiliation: Department of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50937, Köln, Germany, a.schild@gmx.de.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Schild
authors.forename: Julia
authors.initials: J
authors.lastname: Thoenes
authors.forename: Julia
authors.initials: J
authors.lastname: Fricke
authors.forename: Antje
authors.initials: A
authors.lastname: Neugebauer
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006257:Head; D006801:Humans; D008297:Male; D008875:Middle Aged; D009759:Nystagmus, Pathologic / Q000503:physiopathology* / Q000601:surgery*; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D011187:Posture; D012189:Retrospective Studies; D015348:Vision, Binocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult