A prospective evaluation of retroequatorial recession of horizontal rectus muscles and Hertle-Dell'Osso tenotomy procedure in patients with infantile nystagmus with no definite null position

Abstract

Purpose: To compare results of retroequatorial recession of horizontal rectus muscles and Hertle-Dell'Osso tenotomy procedure in patients with infantile nystagmus with null in primary position.

Methods: In this prospective study, 10 subjects ≥5 years of age with infantile nystagmus with null in primary position were randomly assigned to two groups: group 1 underwent a large retroequatorial recession of the four horizontal rectus muscles; group 2, simple tenotomy and resuturing (Hertle-Dell'Osso procedure) of the four muscles. Patients were evaluated using Snellen and logMAR visual acuity charts, contrast sensitivity testing, color vision testing, stereopsis testing (TNO), and electronystagmography (ENG) for nystagmus waveforms, frequency, amplitude, and intensity.

Results: Group 1 patients showed a trend toward 1-line improvement in their visual acuity for distance on the logMAR and ETDRS charts (P = 0.32); there was no improvement in group 2 patients. Contrast sensitivity improved significantly in both groups (P = 0.03), as did stereopsis (P = 0.02 [group 1], P = 0.04 [group 2]). The amplitude and intensity of nystagmus showed a tendancy to decrease in both the groups in all gazes, although the frequency showed no change in either group. Intergroup variability on all the parameters was not statistically significant.

Conclusions: Both retroequatorial recession of horizontal recti and the Hertle-Dell'Osso procedure showed a trend toward reducing ENG amplitude and improved contrast sensitivity and stereopsis in infantile nystagmus with null in primary position.