Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California.
Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Ophthalmology. 2023 Mar;130(3):331-344. doi: 10.1016/j.ophtha.2022.10.006. Epub 2022 Nov 24.
To review the literature on the efficacy of surgical procedures to improve visual acuity (VA) in patients with infantile nystagmus syndrome (INS).
Literature searches were last conducted in January 2022 in the PubMed database for English-language studies with no date restrictions. The combined searches yielded 354 abstracts, of which 46 were reviewed in full text. Twenty-three of these were considered appropriate for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist.
One included study was a randomized trial; the remaining 22 were case series. The 23 studies included children and adults with INS and a variable proportion with anomalous head position (AHP), strabismus, and sensory diagnoses. The surgical interventions evaluated included large recessions, tenotomy and reattachment (TAR), myectomy with or without pulley fixation, and anterior extirpation of the 4 horizontal rectus muscles, as well as various procedures to correct an AHP in which VA was reported as a secondary outcome. The data were mixed, with improvements in binocular best-corrected visual acuity (BCVA) ranging from no improvement to 0.3 logarithm of the minimum angle of resolution (logMAR), or 3 lines. (Most studies were in the range of 0.05-0.2 logMAR.) Statistically significant improvement in VA was noted in 12 of 16 studies (75%) that performed statistical analyses, with no clear advantage of any single procedure. Complications and reoperations were lowest in patients who underwent TAR and highest in those who underwent myectomy or anterior extirpation.
The best available evidence suggests that eye muscle surgery in patients with INS results in a modest improvement in VA.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
综述手术改善婴儿型眼球震颤综合征（INS）患者视力（VA）的疗效的文献。
于 2022 年 1 月在 PubMed 数据库中进行了最后一次英文文献检索，无时间限制。联合检索产生了 354 篇摘要，其中 46 篇进行了全文审查。其中 23 篇被认为适合纳入本评估，并由小组方法学家分配证据级别。
一项纳入的研究为随机试验；其余 22 项为病例系列研究。这 23 项研究包括 INS 患儿和成人，伴有异常头位（AHP）、斜视和感觉诊断的比例不同。评估的手术干预包括大退缩、肌腱切断和再附着（TAR）、带或不带滑车固定的肌切除术，以及 4 条水平直肌的前切除术，以及各种用于矫正 AHP 的手术，VA 被报告为次要结果。数据参差不齐，双眼最佳矫正视力（BCVA）的改善从无改善到 0.3 对数最小角分辨率（logMAR）或 3 行。（大多数研究在 0.05-0.2 logMAR 范围内。）16 项进行统计学分析的研究中有 12 项（75%）报告 VA 有统计学意义的改善，任何单一手术均无明显优势。接受 TAR 的患者并发症和再次手术率最低，接受肌切除术或前切除术的患者最高。
现有最佳证据表明，INS 患者的眼肌手术可使 VA 适度提高。
参考文献后可能有专有或商业披露。
