J Korean Ophthalmol Soc.  2015 Feb;56(2):263-269. 10.3341/jkos.2015.56.2.263.

Long-Term Outcome and Recurrence of Abnormal Head Posture after Surgery in Patients with Nystagmus

• Seo HJ
• Suh YW
• Cho YA

• KMID: 2216011
• DOI: http://doi.org/10.3341/jkos.2015.56.2.263

Abstract

PURPOSE
To evaluate the long-term outcome and recurrence of abnormal head posture after modified Kestenbaum surgery in patients with nystagmus.
METHODS
The medical records of 46 patients who underwent modified Kestenbaum procedure in horizontal recti muscles for nystagmus with abnormal head turn were retrospectively reviewed. We assessed the effect of surgery by comparing preoperative and postoperative clinical data such as visual acuity (log MAR) and degree of head turn. A reoperation or abnormal head turn of 10degrees or more at final visit were defined as recurrence. Patients were divided into 2 groups according to the presence of recurrence or reoperation. Clinical factors associated with recurrence or reoperation were compared between the 2 groups.
RESULTS
The mean visual acuity was 0.38 in the better eye and 0.42 in the worse eye before surgery, which improved to 0.15 and 0.21 after surgery (each p < 0.001), with a mean follow-up period of 124 months. The mean degree of head turn was 41.41degrees preoperatively and was changed to 2.61degrees postoperatively (p < 0.001). The recurrence rate was 23.9% and the reoperation rate was 10.9%. Mental retardation, amblyopia, preoperative visual acuity, degree of head turn, and presence of strabismus were not associated with recurrence or reoperation. The mean age at first surgery was significantly lower in the reoperation group (p = 0.009). The mean visual acuity in the better eye at postoperative 6 months and in better and worse eyes at postoperative 1 year was significantly worse in the reoperation group (p = 0.034, 0.012 and 0.009, respectively).
CONCLUSIONS
The visual acuity and head turn was improved after modified Kestenbaum surgery in patients with nystagmus and abnormal head posture. The reoperation rates were associated with earlier age of first operation and worse postoperative visual acuity. However, further prospective studies are necessary to clarify these factors.

Keyword

Abnormal head posture; Head turn; Kestenbaum; Nystagmus; Recurrence

MeSH Terms

Amblyopia
Follow-Up Studies
Head*
Humans
Intellectual Disability
Medical Records
Muscles
Posture*
Recurrence*
Reoperation
Retrospective Studies
Strabismus
Visual Acuity

Figure

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  Figure 1. Change in the visual acuity after the modified Kestenbaum surgery in the patients with nystagmus and abnor-mal head turn.

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  Figure 2. Change in the degree of head turn after the modified Kestenbaum surgery in the patients with nystagmus and abnormal head turn.

Reference

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