RESUMO
Management of head tilt in infantile nystagmus syndrome (INS) is a challenge. In this case report, we have described successful management of right-sided head tilt in a child with INS by operating on three oblique muscles (superior oblique anterior tenectomy in the right eye, Harada–Ito procedure in the left eye, and inferior oblique recession in the left eye). The child had complete correction of head tilt without causing any cyclovertical strabismus or torsional diplopia postoperatively.
RESUMO
PURPOSE: To investigate clinical findings, diagnostic criteria and management for patients with congenital periodic alternating nystagmus (PAN). METHODS: A retrospective analysis of clinical findings and electrooculography (EOG) of patients with congenital PAN was performed. Thirteen patients diagnosed with congenital PAN from March 1992 to December 2002 were included. RESULTS: Of 13 patients, the median age at initial visit was 7 years old (range: 1 to 30 years). Eight patients had abnormal head posture. The mean value for the period of alteration was 265.7 seconds. Six patients who received either the modified Kestenbaum-Anderson procedure or four rectus muscle recession showed a significant decrease in amplitude and/or frequency of nystagmus, and showed statistically significant improvement in visual acuity in LogMAR after the procedures by 0.33+/-0.09 in right eye, 0.34+/-0.11 in the left eye, compared with preoperative acuities of 0.43+/-0.19 and 0.38+/-0.09 respectively. CONCLUSIONS: Congenital PAN requires the evaluation of nystagmus along with a thorough evaluation of eye movement and EOG. Close follow is necessary to evaluate the pattern of nystagmus. Also, either modified Kestenbaum-Anderson procedure or four rectus muscle recession could be effective, depending on the presence of abnormal head posture.