Modified Anderson Procedure in Infantile Nystagmus with Face Turn within 30 Degrees

Sang Cheol Yang; Hyeshin Jeon; Hee Young Choi

doi:10.3341/jkos.2019.60.6.569

Journal List > J Korean Ophthalmol Soc > v.60(6) > 1127201

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Yang, Jeon, and Choi: Modified Anderson Procedure in Infantile Nystagmus with Face Turn within 30 Degrees

Original Article

Journal of the Korean Ophthalmological Society 2019; 60(6): 569-574.

Published online: 17 June 2019

DOI: https://doi.org/10.3341/jkos.2019.60.6.569

Modified Anderson Procedure in Infantile Nystagmus with Face Turn within 30 Degrees

Sang Cheol Yang, MD¹, Hyeshin Jeon, MD^1,², Hee Young Choi, MD, PhD^1,²

¹Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea.

²Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.

Address reprint requests to Hee Young Choi, MD, PhD. Department of Ophthalmology, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan 49241, Korea. Tel: 82-51-240-7324, Fax: 82-51-240-7341, hychoi@pusan.ac.kr

Received 10 January 2019 Revised 16 February 2019 Accepted 17 May 2019

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the efficacy of modified Anderson procedure in infantile nystagmus with face turn less than 30 degrees.

Methods

This study was a retrospective review of the medical records of 13 consecutive patients who underwent a modified Anderson procedure for abnormal head position in infantile nystagmus at Pusan National University hospital from February 2002 to March 2017. We compared best-corrected visual acuity (logarithm of minimal angle of resolution, logMAR), refraction, degree of face turn, ocular motility, and angle of deviation preoperatively and at 1 week postoperatively, 6 months postoperatively, and the final visit. Recession of the yoke rectus muscles responsible for the slow phase of nystagmus was performed, depending on the direction of face turn; the medial rectus muscle of the eye to which the head was turned was recessed 10 mm, whereas the lateral rectus muscle of the contralateral eye was recessed 12 mm.

Results

The mean age of the patients was 8.9 (2–25) years, and the mean follow-up period after surgery was 51.3 (6–183) months. Twelve patients (92.3%) had no residual head posture or <10° at 6 months postoperatively, and three patients (23.1%) achieved this outcome with an additional operation. The mean degrees of face turn were 22.30° before surgery and 3.85° post-operatively (p = 0.001). Best-corrected visual acuity (logMAR) was 0.41 in the better eye and 0.50 in the worse eye before surgery; this improved to 0.34 and 0.45 at 6 months postoperatively (p = 0.068 and p = 0.228, respectively). Despite the large recessions involved, only one patient showed mild limitation of abduction after surgery.

Conclusions

The modified Anderson procedure may be effective for correcting abnormal head position in infantile nystagmus with face turn less than 30 degrees; patients were not overcorrected.

Keywords: Abnormal head position, Modified Anderson procedure, Nystagmus

Figures and Tables

Table 1

Changes in abnormal head position and strabismus before and after Modified Anderson procedure in patients with nystagmus and abnormal head position

The amount of face turn is in degrees.

M = male; H = horizontal; P = pendular; RMR = right medial rectus; LLR = left lateral rectus; R = face turn to right; Ortho = orthophoria; J = jerk; L = face turn to left; RIO = right inferior oblique; LSO = left superior oblique; F = female; RLR = right lateral rectus; ET = esotropia; XT = exotropia; LMR = left medial rectus; T = torsional.

^*Overcorrected patients; ^†combined strabismus operation.

Table 2

Changes in the clinical characteristics after Modified Anderson procedure in patients with nystagmus and abnormal head position

Values are presented as mean ± standard deviation unless otherwise indicated.

^*Wilcoxon signed rank test, which compared preoperative and postoperative data.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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