High-dose Anderson operation for nystagmus-related anomalous head turn.

Abstract

To evaluate the effectiveness of a high-dose Anderson procedure (AP) to correct infantile nystagmus-related anomalous head turn (HT). Twenty-nine consecutive orthotropes with infantile nystagmus with and without associated sensory defect received high-dose AP. HT was measured while the patient tried to read letters at best-corrected visual acuity (BCVA) level at 5m and 0.3m. BCVA, binocular vision (BV), and alignment (prism and cover test) were measured. High-dose AP with recessions of 9-16mm was performed. All measures were taken before and 3-6 and ≥ 8months post surgery. Success was defined by postoperative HT ≤ 10°/HT ≤ 15°. Medians and ranges (minimum-maximum) were:. Age at surgery was7years (4-44). HT at 5m and HT at 0.3m were35° (20-40) and 20° (0-35), respectively. After 4months (3-6), HT was 10° (- 3-20) and 5° (- 5-20); success rates were 74%/96% and 83%/96%. After 15months (8-45), HT was 12° (0-20) and 6° (0-15); success rates were 46%/75% and 92%/100%; residual HT > 15° occurred in 5/9 cases with recessions < 13mm and 1/15 cases with recessions ≥ 13mm. With recessions ≥ 13mm, 60% (95% confidence intervals (C.I.), 33-83%) achieved HT ≤ 10° and 93% (95% C.I. 66-99%) achievedHT ≤ 15°. Overcorrection did not occur. Anomalous head posture components in vertical and frontal planes did not improve. Residual motility was 30° (10-45). The mean BCVA improved by only 0.037 logMAR (p = 0.06). BV and ocular alignment were constant, except in 2 patients whose exophoria decompensated. Kestenbaum surgery is a common procedure to correct infantile nystagmus-related HT. Anderson surgery is confined to bilateral yoke muscle recession; hence, less invasive but nevertheless comparably effective, high dosage is provided.