title: Effects of augmented tenotomy and reattachment in the infantile nystagmus syndrome.
abstract: OBJECTIVE
  To test the hypothesis that augmented tenotomy and reattachment surgery (AT-R), which involves placing an additional suture in each distal tendon during the 4-muscle tenotomy and reattachment (T-R) or other infantile nystagmus syndrome (INS) procedures, could increase the beneficial effects of many types of extraocular muscle (EOM) surgery to treat INS.
  
  
  METHODS
  Both infrared reflection and high-speed digital video systems were used to record the eye movements in 4 patients with INS before and after AT-R surgery. Data were analyzed using the eXpanded Nystagmus Acuity Function (NAFX) that is part of the OMtools software.
  
  
  RESULTS
  Placement of the augmentation suture did not interfere with Kestenbaum, Anderson, bilateral medial rectus muscle recession, or T-R surgeries. The therapeutic effects of AT-R were similar to but not equal to those from the traditional single-suture surgeries (ie, broadening longest foveation domain [LFD] but no improvement of NAFX peak). The average of the NAFX percent improvements after AT-R was within 31% of those estimated from NAFX values before T-R; the average of the percent broadenings of the LFD values after AT-R was within 16%.
  
  
  CONCLUSIONS
  The AT-R does not improve the foveation quality in INS above the traditional T-R surgery. It is not improved by an additional suture; indeed, some improvements may be diminished by the added suture. The hypothesized augmented-tendon suture technique (sans tenotomy) has been modified and remains to be tested.
authors.affiliation: Daroff-Dell'Osso Ocular Motility Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center and CASE Medical School, Cleveland, Ohio;; Departments of Neurology, Ophthalmology, Cleveland, Ohio.
authors.forename: Louis F
authors.initials: LF
authors.lastname: Dell'Osso
authors.affiliation: Departments of Biomedical Engineering, Cleveland, Ohio.
authors.forename: Faruk H
authors.initials: FH
authors.lastname: Orge
authors.affiliation: Daroff-Dell'Osso Ocular Motility Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center and CASE Medical School, Cleveland, Ohio;; Departments of Neurology, Ophthalmology, Cleveland, Ohio; Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Jacobs
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005133:Eye Movements / Q000502:physiology*; D005260:Female; 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 / Q000379:methods*; D058971:Tenotomy / Q000379:methods*; D014741:Video Recording / Q000295:instrumentation; D055815:Young Adult