Journal List > J Korean Ophthalmol Soc > v.60(8) > 1130597

Park, Han, Lee, and Han: Surgical Management of Concurrent Strabismus and Face Turn in Patients with Infantile Nystagmus

Abstract

Purpose

To investigate the effect of adjusted Kestenbaum surgery in patients with idiopathic infantile nystagmus who were affected by both strabismus and face turn.

Methods

This retrospective consecutive case series included 12 patients with infantile nystagmus who had face turn and strabismus. All patients underwent adjusted Kestenbaum surgery between 1996 and 2014, and primary outcome measures were the postoperative degree of face turn and strabismus.

Results

All patients had jerky nystagmus with compensatory face turn and strabismus. Of the 12 patients, eight patients were exotropes and four patients were esotropes. The mean age at surgery was 12.5 ± 10.7 years (range, 2–36 years). The mean postoperative follow-up was 17.8 ± 12.0 months (range, 7–43 months). Surgery was successful in eight (66.7%) out of 12 patients. Improvement of anomalous head posture was satisfactory in all patients, but an angle of deviation within 10 prism diopters was not achieved in four patients.

Conclusions

Adjusted Kestenbaum surgery simultaneously improved both ocular misalignment and face turn with one-stage surgery. Two or three rectus muscles surgery can be considered in these patients because it is not only simpler than four muscles surgery but also can preserve one or two rectus muscles.

Figures and Tables

Figure 1

Case 7. (A, B) At 5 years of age 30Δ alternating exotropia was noted with Krimsky methods. She had left face turn of 15° and slight chin down posture. (C, D) After adjusted Kestenbaum surgery to correct both exotropia and face turn, she had nearly orthophoria at near with Krimsky methods. She had slight chin down posture to maximize visual acuity. The patient consented to the use of this photography.

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Table 1

Surgical table of adjusted Kestenbaum procedure in patients with infantile nystagmus who had face turn and strabismus (to correct the right face turn)

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PD = prism diopters; LR = lateral rectus; MR = medial rectus; Exo = exotropia; Eso = esotropia.

Table 2

Preoperative and postoperative data of patients with infantile nystagmus who had face turn and strabismus

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EOM = extraocular motility; M = male; RBJ = right beat jerk; RET = right esotropia; R = right; RMR = right medial rectus; Rec = recession; LMR = left medial rectus; Res = resection; RLR = right lateral rectus; LLR = left lateral rectus; ortho = orthophoria; AET = alternating esotropia; LBJ = left beating jerk; F = female; LXT = left exotropia; L = left; AXT = alternating exotropia; RXT = right exotropia.

Notes

Conflicts of Interest The authors have no conflicts to disclose.

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