Gräf Michael, Hausmann Anja, Lorenz Birgit
Department of Ophthalmology, Justus-Liebig-University Giessen, Giessen, Germany.
Universitaetsklinikum Giessen and Marburg GmbH, Campus Giessen, Friedrichstr. 18, 35385, Giessen, Germany.
Graefes Arch Clin Exp Ophthalmol. 2019 Sep;257(9):2033-2041. doi: 10.1007/s00417-019-04369-0. Epub 2019 Jun 14.
To evaluate the effectiveness of a high-dose Anderson procedure (AP) to correct infantile nystagmus-related anomalous head turn (HT).
Twenty-nine consecutive orthotropes with infantile nystagmus with and without associated sensory defect received high-dose AP. HT was measured while the patient tried to read letters at best-corrected visual acuity (BCVA) level at 5 m and 0.3 m. BCVA, binocular vision (BV), and alignment (prism and cover test) were measured. High-dose AP with recessions of 9-16 mm was performed. All measures were taken before and 3-6 and ≥ 8 months post surgery. Success was defined by postoperative HT ≤ 10°/HT ≤ 15°.
Medians and ranges (minimum-maximum) were:. Age at surgery was 7 years (4-44). HT at 5 m and HT at 0.3 m were 35° (20-40) and 20° (0-35), respectively. After 4 months (3-6), HT was 10° (- 3-20) and 5° (- 5-20); success rates were 74%/96% and 83%/96%. After 15 months (8-45), HT was 12° (0-20) and 6° (0-15); success rates were 46%/75% and 92%/100%; residual HT > 15° occurred in 5/9 cases with recessions < 13 mm and 1/15 cases with recessions ≥ 13 mm. With recessions ≥ 13 mm, 60% (95% confidence intervals (C.I.), 33-83%) achieved HT ≤ 10° and 93% (95% C.I. 66-99%) achieved HT ≤ 15°. Overcorrection did not occur. Anomalous head posture components in vertical and frontal planes did not improve. Residual motility was 30° (10-45). The mean BCVA improved by only 0.037 logMAR (p = 0.06). BV and ocular alignment were constant, except in 2 patients whose exophoria decompensated.
Kestenbaum surgery is a common procedure to correct infantile nystagmus-related HT. Anderson surgery is confined to bilateral yoke muscle recession; hence, less invasive but nevertheless comparably effective, high dosage is provided.
评估高剂量安德森手术（AP）矫正婴儿型眼球震颤相关异常头位（HT）的有效性。
29例连续的矫正视力正常的婴儿型眼球震颤患者，伴有或不伴有相关感觉缺陷，接受了高剂量AP手术。在患者试图在5米和0.3米的最佳矫正视力（BCVA）水平阅读字母时测量HT。测量BCVA、双眼视觉（BV）和眼位（棱镜和遮盖试验）。进行了后退量为9 - 16毫米的高剂量AP手术。所有测量均在手术前、术后3 - 6个月和≥8个月时进行。成功的定义为术后HT≤10°/HT≤15°。
中位数和范围（最小值 - 最大值）为：手术年龄为7岁（4 - 44岁）。5米处的HT和0.3米处的HT分别为35°（20 - 40°）和20°（0 - 35°）。4个月（3 - 6个月）后，HT为10°（ - 3 - 20°）和5°（ - 5 - 20°）；成功率分别为74%/96%和83%/96%。15个月（8 - 45个月）后，HT为12°（0 - 20°）和6°（0 - 15°）；成功率分别为46%/75%和92%/100%；后退量<13毫米的9例中有5例残余HT>15°，后退量≥13毫米的15例中有1例残余HT>15°。后退量≥13毫米时，60%（95%置信区间（C.I.），33 - 83%）达到HT≤10°，93%（95% C.I. 66 - 99%）达到HT≤15°。未发生过矫。垂直和额面的异常头位成分未改善。残余眼球运动度为30°（10 - 45°）。平均BCVA仅提高了0.037 logMAR（p = 0.06）。BV和眼位保持不变，2例患者的外斜视失代偿除外。
凯斯滕鲍姆手术是矫正婴儿型眼球震颤相关HT的常见手术。安德森手术仅限于双侧配偶肌后退；因此，侵入性较小但同样有效，提供了高剂量。
