Vertical rectus muscle surgery for nystagmus patients with vertical abnormal head posture

Abstract

Purpose: To characterize the results of vertical rectus muscle recession, or recession and resection surgery for vertical abnormal head posture (VAHP) due to null-point nystagmus.

Method: This is a retrospective, noncomparative, consecutive case series of patients who underwent vertical rectus muscle recession alone, recession then resection, or combined recession/resection surgery for VAHP due to null-point nystagmus. The primary outcome measure was the amount of residual VAHP.

Results: Twenty patients with VAHP due to null-point nystagmus were studied. The mean follow-up interval after surgery was 49 months (median: 44 months; range 9 to 124 months). Preoperative VAHP ranged from 10 degrees to 45 degrees, and the total amount of bilateral vertical rectus muscle recession, or recession and resection surgery, ranged from 8.5 to 20.0 mm per eye. After recession alone, 5/11 had residual VAHP < or = 5 degrees. The remaining six underwent subsequent resection or plication for residual VAHP > 10 degrees that resulted in residual VAHP < or = 5 degrees in each case. After combined recession/resection, 6/9 had residual VAHP < or = 5 degrees and the remaining three had VAHP < 10 degrees.

Conclusion: Large amounts of vertical rectus muscle surgery are indicated to successfully correct the VAHP associated with nystagmus with a vertical null point. Combined recession/resection of the appropriate vertical rectus muscles, instead of recession alone, appears to be a more effective procedure.