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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.
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)
Table 2
Preoperative and postoperative data of patients with infantile nystagmus who had face turn and strabismus
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.
References
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