Dubner Michael, Nelson Leonard B, Gunton Kammi B, Lavrich Judith, Schnall Bruce, Wasserman Barry N
J Pediatr Ophthalmol Strabismus. 2016 Jan-Feb;53(1):16-21. doi: 10.3928/01913913-20160113-03.
To document prospectively the effect of four-muscle tenotomy surgery on visual acuity (VA) and nystagmus intensity and assess, by the use of a questionnaire, the experience of adult patients and the parents of children who have had the four-muscle tenotomy procedure for nystagmus in the absence of strabismus or an anomalous head position. The qualitative perceived benefits or lack thereof from the procedure were compared to the subjective effects on nystagmus intensity and VA.
Fifteen patients diagnosed as having congenital/infantile or acquired nystagmus, including albinism or other visual sensory disorders without anomalous head positions or coexisting strabismus, were included in this study. The changes in preoperative and postoperative VA and nystagmus were evaluated based on clinical and perceptual measurements and video recordings.
All 15 patients had preoperative and postoperative ophthalmological examinations. One patient had a postoperative conjunctival cyst, which was successfully removed. Fourteen patients (93%) showed clinical VA improvement in at least one eye. Fourteen patients were video recorded preoperatively and postoperatively to analyze their nystagmus intensity; case 9 was not included. Postoperatively, 10 patients (71%) showed a decrease in nystagmus intensity. Thirteen patients (87%) perceived vision improvement and 11 patients (73%) perceived a decrease in nystagmus intensity. All patients experienced either clinically improved VA or a decrease in nystagmus intensity. Fourteen patients (93%) perceived either improved VA or a decrease in nystagmus intensity. The preoperative and postoperative changes in VA (P = .002) and nystagmus intensity (P = .043) were both statistically significant.
The authors have shown that four-muscle tenotomy surgery for nystagmus can improve VA and decrease nystagmus intensity. The study yielded subjective patient satisfaction, modest objective improvement in VA, and no significant complications.
前瞻性记录四肌切断术对视力（VA）和眼球震颤强度的影响，并通过问卷调查评估在无斜视或异常头位情况下接受四肌切断术治疗眼球震颤的成年患者及儿童家长的体验。将该手术定性的感知益处或缺乏益处与对眼球震颤强度和视力的主观影响进行比较。
本研究纳入了15例被诊断为先天性/婴儿期或后天性眼球震颤的患者，包括白化病或其他无异常头位或并存斜视的视觉感觉障碍患者。基于临床和感知测量以及视频记录评估术前和术后视力及眼球震颤的变化。
所有15例患者均接受了术前和术后眼科检查。1例患者术后出现结膜囊肿，已成功切除。14例患者（93%）至少一只眼的临床视力有改善。14例患者术前和术后进行了视频记录以分析其眼球震颤强度；病例9未纳入。术后，10例患者（71%）眼球震颤强度降低。13例患者（87%）感觉视力改善，11例患者（73%）感觉眼球震颤强度降低。所有患者的视力在临床上均有改善或眼球震颤强度降低。14例患者（93%）感觉视力改善或眼球震颤强度降低。视力（P = .002）和眼球震颤强度（P = .043）的术前和术后变化均具有统计学意义。
作者表明，四肌切断术治疗眼球震颤可改善视力并降低眼球震颤强度。该研究获得了患者主观满意度，视力有适度客观改善，且无明显并发症。
