Correspondence - ICO Library

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Binocular Vision & A Novel New [Yet Again] Procedure for Correction of FIRST Quarter of 2011
Strabology Quarterly© Com pensatory Head Posture in Infantile Nystagm us: Augm ented Anderson Plus Volum e 26 (No.1)
A M edical Scientific e-Periodical J. E. Bishop, M D Pages 37-42
INTRODUCTION
Compensatory head posture associated
with infantile nystagmus is well described.
Classic approaches for correcting an abnormal
head posture, a head (face) turn with gazeshifting
surgery include the Kestenbaum
procedure (1), and the Anderson procedure(2).
Others have advocated nystagmus
reduction procedures to achieve head posture
correction. Helveston (3) suggested maximal
four horizontal rectus recessions. Dell'Osso
and Hertle (4) described four horizontal rectus
tenotomy and reattachment surgery for
nystagmus damping. More recently, last year,
Hertle et al (Binoc Vis Strab Q. 25:72-93,
2010) reported seven subjects who underwent
an Anderson procedure combined with
tenotomy and reattachment of the remaining
horizontal rectus muscles (5). See discussion
on page 39,40 for further details of
background history.
This report describes the author's contemporaneous
detailed experience with combining
the gaze-shifting principle of an augmented
Anderson procedure with the nystagmus
reducing principle of tenotomy and reattachment
of all four horizontal rectus muscles.
SUBJECTS and METHODS
Under Driscoll Children’s Hospital
Institutional Review Board approval, and in
compliance with the requirements of the
United States Health Insurance Portability and
Privacy Act, (HIPPA) the clinical records of
five subjects receiving simultaneous gazeshifting
and nystagmus reduction surgery
were retrospectively reviewed.
All patients had onset of horizontal
nystagmus in early infancy which remained
horizontal in upgaze and did not produce
oscillopsia. None had serious visual loss,
structural signs of albinism, optic nerve
hypoplasia, photophobia or paradoxical
pupillary phenomena to suggest a congenital
retinal dystrophy. None had neurologic
disease or developmental delay.
All procedures were performed by the
author between July 2009 andJuly2010. With
parental informed consent, all patients
received an augmented Anderson procedure
(recessing one medial rectus muscle 7-8 mm
and recessing the contralateral lateral rectus
muscle 9-10.5 mm) combined with tenotomy
and reattachment surgery on the remaining
two horizontal rectus muscles. Pre- and postoperative
head posture, nystagmus and
monocular best-corrected visual acuities were
assessed by the author solely employing
clinical observations, measuring head turn
with a goniometer.
RESULTS
The five subjects consisted of three
males and two females with typically habitual
abnormal head posture secondary to idiopathic
infantile nystagmus, aged 25-141 months
(mean 64 months, median 56 months). The
Table, top next page, outlines the clinical
data. Pre-operative horizontal head turn ranged
from 14° to 40° (mean 19.6°, median 19°).
Postoperatively, all their head turns
were improved, with a residual same-sided
head turn range of 2° - 11° (mean 4.2°, median
3°). Mean correction was 79% of the preoperative
angle. The net angle of correction
ranged from 10° - 29° (mean 17.4° and median
17°). Follow-up ranged from one day
(subject lost to follow-up) to 345 days, with a
mean of 132 days and a median of 48 days.
Monocular visual acuity improved by
one Snellen line in three eyes, improved less