Modified Anderson Procedure in Infantile Nystagmus with Face Turn within 30 Degrees

PURPOSE: To evaluate the efficacy of modified Anderson procedure in infantile nystagmus with face turn less than 30 degrees. METHODS: This study was a retrospective review of the medical records of 13 consecutive patients who underwent a modified Anderson procedure for abnormal head position in infantile nystagmus at Pusan National University hospital from February 2002 to March 2017. We compared best-corrected visual acuity (logarithm of minimal angle of resolution, logMAR), refraction, degree of face turn, ocular motility, and angle of deviation preoperatively and at 1 week postoperatively, 6 months postoperatively, and the final visit. Recession of the yoke rectus muscles responsible for the slow phase of nystagmus was performed, depending on the direction of face turn; the medial rectus muscle of the eye to which the head was turned was recessed 10 mm, whereas the lateral rectus muscle of the contralateral eye was recessed 12 mm. RESULTS: The mean age of the patients was 8.9 (2–25) years, and the mean follow-up period after surgery was 51.3 (6–183) months. Twelve patients (92.3%) had no residual head posture or <10° at 6 months postoperatively, and three patients (23.1%) achieved this outcome with an additional operation. The mean degrees of face turn were 22.30° before surgery and 3.85° post-operatively (p = 0.001). Best-corrected visual acuity (logMAR) was 0.41 in the better eye and 0.50 in the worse eye before surgery; this improved to 0.34 and 0.45 at 6 months postoperatively (p = 0.068 and p = 0.228, respectively). Despite the large recessions involved, only one patient showed mild limitation of abduction after surgery. CONCLUSIONS: The modified Anderson procedure may be effective for correcting abnormal head position in infantile nystagmus with face turn less than 30 degrees; patients were not overcorrected.

The Effect of Modified Kestenbum Procedure (6-7-6-7mm) for Abonormal Heal Position in Infantile Nystagmus

We assessed the efficacy of modified Kestenbaum procedure for the correction of abnormal head position in 16 patients with the diagnosis of in fantile nystagmus. Instead of Parks 5-6-7-8mm modified Kestenbaum procedure, we performed 6-7-6-7mm modified Kestenbaum on 11 patients with head turn of 20-30, 20% augmented procedure(7.2-8.4-7.2-8.4mm) on 4 patients with head turn of 30 or more, and-1mm procedure(5-6-5-6mm) on 1 patent with head turn of less than 20. In the average follow-up of 7 months, 10 patients(62.5%) showed head turn of less than 5, in which 14 of 16 patients had less than10 .87.5% of the patients showed satisfactory correction of abnormal head position., 12 prism diopter of exotropia was noted postoperatively in 1 case but the duction was not limited in any case. From the above results, we conclude that 6-7-6-7mm modified Kestenbaum nystagmus.

The Effect of Kestenbaum Procedure for Abnormal Head Position in Infantile Nystagmus

We performed modified Kestenbaum procedures for correction of abnormal head position in 24 patients with infantile nystagmus. Preoperatively, the degree of head turn ranged from 15 degrees to 45 degrees. For 12 patients with head turn of 15 degrees ~ 30 degrees, 5-6-7-8 modified Kestenbaum procedures were performed. For 9 patients with head turn of 30-40, 20% augmented Kestenbaum procedures were performed and one patient with a 45degree head turn underwent a 30% augmented Kestenbaum procedure. Two patients with vertical chin down underwent 6-7mm recessions of both superior rectus muscles and 5mm resections of both inferior rectus muscles. In the follow-up of an average 12 months, 20 out of 24 patients showed no residual head turn or head turn less than 10 degrees. The modified Kestenbaum procedure could correct the abnormal head position successfully in 83% of infantile nystagmus with one operation. From the above results, we found that the proper amounts of Kestenbaum surgery were 5-6-7-8mm for 25 degrees or less than 25 degrees head turn, 20% augmentation for 30 degrees head turn and 30% or more augmentation for 40 degrees or more head turn.