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A prospective clinical evaluation of augmented Anderson procedure for idiopathic infantile nystagmus
Ritesh Gupta1, Pradeep Sharma, Vimala Menon
1Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Insights
The augmented Anderson procedure effectively corrects head posture in idiopathic infantile nystagmus (IIN). This surgery improves visual acuity and reduces nystagmus intensity in the primary position.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Surgery
Background:
- Idiopathic infantile nystagmus (IIN) is a common cause of visual impairment in children.
- Anomalous head posture is frequently associated with IIN, particularly with an eccentric null position.
- Surgical interventions aim to improve head posture and visual function.
Purpose of the Study:
- To evaluate the efficacy of the augmented Anderson procedure for treating idiopathic infantile nystagmus (IIN).
- To assess the impact of the surgery on head posture, visual acuity, and nystagmus intensity.
Main Methods:
- Twelve patients over 5 years old with IIN and anomalous head posture underwent the augmented Anderson procedure.
- The procedure involved recession of yoke muscles (medial and lateral rectus).
- Pre- and post-operative measurements included visual acuity, head position, and eye movements at 3 months.
Main Results:
- Significant improvement in anomalous head posture was observed in all patients (p = 0.0001).
- Nystagmus intensity in the primary position decreased significantly post-surgery (p = 0.006).
- Binocular visual acuity in the primary position also showed significant improvement (p = 0.007).
Conclusions:
- The augmented Anderson procedure is effective in correcting face turn in IIN patients with eccentric null positions.
- The surgery leads to improved visual acuity and reduced nystagmus intensity.
- Longer follow-up studies are needed to confirm long-term efficacy.
Purpose:
To evaluate the efficacy of the augmented Anderson procedure in idiopathic infantile nystagmus (IIN).
Methods:
Twelve consecutive patients older than 5 years having IIN with eccentric null position and anomalous head position were enrolled in an institution-based study. Best-corrected visual acuity (uniocular and binocular and in both null position and primary position), slit-lamp examination, fundus examination, ocular motility examination, and stereopsis using TNO were recorded. In all cases the augmented Anderson procedure, that is, recession of the yoke muscles (9-mm medial rectus and 12-mm lateral rectus), was performed. Eye movements were recorded before and 3 months after surgery in the primary position, right gaze 15 and 30 degrees, and left gaze 15 and 30 degrees.
Results:
All patients had improvement in their anomalous head posture after surgery (p = 0.0001). The nystagmus intensity in the primary position decreased from 22.0 +/- 15.9 degrees cycles/s preoperatively to 10.6 +/- 10.2 degrees cycles/s at 3 months postoperatively. The change was statistically significant (p = 0.006). After surgery, binocular visual acuity using the Early Treatment Diabetic Retinopathy Study chart improved in primary position (p = 0.007). No patient developed more than mild limitation of horizontal movements after surgery.
Conclusion:
The augmented Anderson procedure is successful in correcting face turn in patients having IIN with eccentric null position, resulting in an increase in visual acuity and a decrease in nystagmus intensity in primary position. Further studies with a longer follow-up are required to assess the long-term efficacy of this procedure.
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