Kumar Priyanka, Lambert Scott R
a Department of Ophthalmology , Children's Hospital of Pennsylvania , Philadelphia , PA , USA.
b Department of Ophthalmology , Stanford University School of Medicine , Stanford , CA , USA.
Strabismus. 2018 Sep;26(3):150-154. doi: 10.1080/09273972.2018.1497667. Epub 2018 Jul 30.
To report outcomes of vertical extraocular muscle surgery to correct abnormal vertical head posture in children with horizontal infantile nystagmus.
Retrospective case series of seven patients evaluated at one institution with abnormal vertical head position (chin-up or chin-down) in the setting of horizontal infantile nystagmus. All patients underwent bilateral vertical extraocular muscle surgery with the same surgeon. Pre- and postoperative vertical head position under binocular viewing conditions was the primary outcome measure. Secondary outcomes included visual acuity, stereopsis, degree of cyclotorsion, and residual ocular alignment.
Seven children with infantile nystagmus syndrome, ranging in age from 4 months to 5 years at presentation, underwent extraocular muscle surgery to correct chin-down or chin-up head position associated with a null position in the setting of horizontal nystagmus. Five children had other ocular pathology (albinism, n = 4; cone-rod dystrophy, n = 1). Five of the seven patients had combined vertical recti and oblique muscle surgery. Three of the patients had additional extraocular muscle surgery to correct horizontal misalignment (exotropia, n = 2; esotropia, n = 1). One patient underwent a separate Kestenbaum procedure (bilateral horizontal resection/recession) to correct concomitant horizontal face turn. Median postoperative follow-up was 8.0 years (range 1-9.5 years). Postoperatively, three patients had complete resolution of their abnormal head position, and three had an improvement in their head posture, with a mean reduction in original vertical head position of 25 degrees. One of these patient had a reversal of their head position from a chin-up to a small chin-down position. Only one patient had no clinically significant improvement in their head position. No patients had signs or symptoms of cyclotorsion postoperatively.
Combined vertical recti and oblique muscle surgery can successfully improve and even resolve vertical head posture, and prevents cyclorotary disorders postoperatively.
报告垂直性眼外肌手术矫正水平型婴儿型眼球震颤患儿异常垂直头位的效果。
对在一家机构接受评估的7例水平型婴儿型眼球震颤伴异常垂直头位（抬头或低头）患儿进行回顾性病例系列研究。所有患者均由同一位外科医生进行双侧垂直性眼外肌手术。双眼注视条件下术前和术后的垂直头位是主要观察指标。次要观察指标包括视力、立体视、旋转斜视程度和残余眼位偏斜。
7例婴儿型眼球震颤综合征患儿，就诊时年龄4个月至5岁，接受眼外肌手术以矫正水平性眼球震颤零位时的低头或抬头头位。5例患儿有其他眼部病变（白化病4例；视锥视杆营养不良1例）。7例患者中有5例同时进行了垂直直肌和斜肌手术。3例患者还进行了额外的眼外肌手术以矫正水平斜视（外斜视2例；内斜视1例）。1例患者接受了单独的Kestenbaum手术（双侧水平直肌后徙/缩短术）以矫正伴随的水平性面转。术后中位随访时间为8.0年（范围1 - 9.5年）。术后，3例患者的异常头位完全消失，3例患者的头位有所改善，原垂直头位平均降低25度。其中1例患者的头位从抬头转为轻度低头。只有1例患者的头位在临床上无明显改善。术后无患者出现旋转斜视的体征或症状。
垂直直肌和斜肌联合手术可成功改善甚至矫正垂直头位，并预防术后旋转性障碍。
