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. 2009:3:615-24.
doi: 10.2147/opth.s7541. Epub 2009 Nov 16.

Eye muscle surgery for infantile nystagmus syndrome in the first two years of life

Richard W Hertle  1 , Joost Felius, Dongsheng Yang, Matthew Kaufman
Affiliations

Eye muscle surgery for infantile nystagmus syndrome in the first two years of life

Richard W Hertle et al. Clin Ophthalmol. 2009.

Abstract

Purpose: To report visual and elctrophysioloigcal effects of eye muscle surgery in young patients with infantile nystagmus syndrome (INS).

Methods: Prospective, interventional case cohort of 19 patients aged under 24 months who were operated on for combinations of strabismus, an anomalous head posture, and nystagmus. All patients were followed at least nine months. Outcome measures, part of an institutionally approved study, included Teller acuity, head position, strabismic deviation, and eye movement recordings, from which waveform types and a nystagmus optimal foveation fraction (NOFF). Computerized parametric and nonparametric statistical analysis of data were perfomed using standard software on both individual and group data.

Results: Age averaged 17.7 months (13.1-month follow-up). Thirteen (68%) patients had associated optic nerve or retinal disease. 42% had amblyopia, 68% had refractive errors. Group means in binocular Teller acuity (P < 0.05), strabismic deviation (P < 0.05), head posture (P < 0.001), and the NOFF measures (P < 0.01) from eye movement recordings improved in all patients. There was a change in null zone waveforms to more favorable jerk types. There were no reoperations or surgical complications.

Conclusions: Surgery on the extraocular muscles in patients aged less than two years with INS results in improvements in multiple aspects of ocular motor and visual function.

Keywords: anomalous head posture; eye muscle surgery; infantile nystagmus.

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Figures

Figure 1
Figure 1
LogMAR acuity plot data pre- and postoperative. Notes: Preoperative–postoperative unity plot of binocular acuity for the 19 patients showing a significant group improvement. LogMAR scale: the Y axis is LogMAR acuity and the X axis is patient number. Abbreviations: BVA, binocular teller acuity card LogMAR acuity; LogMAR, Log of the minimal angle of resolution.
Figure 2
Figure 2
Unity plot nystagmus optimal foveation fraction pre- and postoperative. Notes: Preoperative postoperative unity plot of NOFF for the 19 patients showing a significant improvement. 0 = no foveation; 1 = complete foveation for selected eye movement segment (see text for NOFF details); circle = patients. Abbreviation: NOFF, nystagmus optimal foveation fraction.
Figure 3
Figure 3
Eye movement recording of patient 2. Notes: Eye movement recording data from patient #2 within one week preoperatively and two months after surgery. The 10-second traces shows a change from irregular pendular, occasional jerk waveforms with floating (unstable) fixation preoperatively to a waveform showing more stable fixation and jerk and foveating saccades, early bidirectional jerk waveforms, one of the most favorable outcomes for visual function in INS patients. Abbreviation: INS, infantile nystagmus syndrome.
Figure 4
Figure 4
Eye movement recording of patient 16. Notes: Eye movement recording data from patient #16 within one week preoperatively and two months after surgery. The 10-second traces shows a change from irregular asymmetric pendular, occasional jerk waveforms with floating (unstable) fixation preoperatively to a waveform showing more stable fixation and jerk with extended foveation, a more favorable outcome for visual function in INS patients. Abbreviation: INS, infantile nystagmus syndrome.
See this image and copyright information in PMC

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