Surgery for horizontal nystagmus

1 April 2017 | Fiona Rowe (Prof) | EYE - Paediatrics, EYE - Strabismus

The authors report two consecutive interventional surgical series in which the authors describe their experience with the Sinskey anterior extirpation procedure (SAEP) and a newly modified myectomy without reattachment (MWR). In a review of 39 patients, 20 underwent the SAEP procedure and 19 underwent the MWR procedure. In the SAEP group, 20 had pendular nystagmus without null zone and three with jerk nystagmus with abnormal head posture. In the MWR group, 15 had pendular nystagmus without null zone and four with jerk nystagmus with abnormal head posture. SAEP had greatest improvement in visual acuity in children aged less than 10 years with an average increase of 3.6 lines a distance and six lines at near. Overall, for SAEP, there was an average increase of 1.7 lines at distance and 2.3 lines for near whilst improvement for the NWR group was 1.5 and 1.2 lines respectively. For all patients, average reduction in nystagmus amplitude was 64.7%: 74.8% for SAEP and 59.8% for MWR. Horizontal versions were more compromised in SAEP. Reoperations were required in five SAEP patients and three MWR patients. The authors conclude that MWR procedure has similar outcomes to SAEP but with less limitation of versions, risk of intraoperative bleeding and risk of postoperative strabismus.