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• W4236697929 abstract "Dr. Burns correctly understood that all patients in our study1Wang Z. Dell’Osso L.F. Jacobs J.B. Burnstine R.A. Tomsak R.L. Effects of tenotomy on patients with infantile nystagmus syndrome: foveation improvement over a broadened visual field.JAAPOS. 2006; 10: 552-560Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar received only the 4-muscle tenotomy procedure on their horizontal rectus muscles (ie, tenotomy of each muscle and resuturing at its original insertion). The horizontal tenotomy procedure for Patient 4, who had a vertical component to her nystagmus, was the first stage in a possible 2-stage therapy. Two studies2Dell’Osso L.F. Flynn J.T. Congenital nystagmus surgery: a quantitative evaluation of the effects.Arch Ophthalmol. 1979; 97: 462-469Crossref PubMed Google Scholar, 3Hertle R.W. Dell’Osso L.F. FitzGibbon E.J. Thompson D. Yang D. Mellow S.D. Horizontal rectus tenotomy in patients with congenital nystagmus Results in 10 adults.Ophthalmology. 2003; 110: 2097-2105Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar have suggested that the beneficial foveation improvements result from the tenotomy and reattachment of all 4 rectus muscles in the major plane of the nystagmus (usually horizontal). Nystagmus surgery must always include the fixating eye. When a patient has strabismus, one cannot shift a nystagmus null by operating on the deviated eye alone. Because the fixating eye drives nystagmus, it is that eye that must be shifted in the nystagmus portion of any procedure (eg, the Anderson recession procedure4Anderson J.R. Causes and treatment of congenital eccentric nystagmus.Br J Ophthalmol. 1953; 37: 267-281Crossref PubMed Google Scholar) whereas the deviated eye may be shifted to a greater or lesser degree to treat the strabismus. In the case of a binocular patient with a convergence null, the medial rectus muscle of each eye is recessed, producing an artificial divergence that induces convergence, even for far targets. At present, we continue to recommend a simultaneous tenotomy procedure on both lateral rectus muscles. However, in the artificial divergence surgery, the 2-muscle recessions (one per eye) may suffice because convergence also broadens the high-acuity range of gaze angles5Serra A. Dell’Osso L.F. Jacobs J.B. Burnstine R.A. Combined gaze-angle and vergence variation in infantile nystagmus: two therapies that improve the high-visual acuity field and methods to measure it.Invest Ophthalmol Vis Sci. 2006; 47: 2451-2460Crossref PubMed Scopus (0) Google Scholar; more data are needed to compare all the beneficial effects of the 2 procedures. Nystagmus surgery is a low-risk, outpatient procedure. Just as tenotomy of all 4 muscles (2 per eye) is required to improve visual function, anesthesia is required, regardless of how many muscles undergo surgery. Postsurgical patient satisfaction is only now being better understood as eye-movement recording and analysis reveal the scope of previously unknown improvements in visual function. Regarding follow-up, both our 1981 study of the long-term effects of the Kestenbaum procedure6Flynn J.T. Dell’Osso L.F. Surgery of congenital nystagmus.Trans Ophthalmol Soc UK. 1981; 101: 431-433PubMed Google Scholar and subsequent recordings of some of the patients in the 2000-2002 NIH tenotomy study showed that the beneficial effects were permanent (5 years after both procedures). Scarring and healing begin in 1-4 weeks and are complete within 4-6 weeks; foveation improvements are immediate (documented 1 day after tenotomy in a canine and 6 days in humans). We have no data suggesting that either reinnervation occurs or that negation of the beneficial effects would result if it did. Effects of tenotomy on patients with infantile nystagmus syndrome: Foveation improvement over a broadened visual fieldJournal of American Association for Pediatric Ophthalmology and Strabismus {JAAPOS}Vol. 10Issue 6PreviewTo investigate the effects of four-muscle tenotomy on visual function and gaze angle in patients with infantile nystagmus syndrome (INS). Full-Text PDF Effects of tenotomy on patients with infantile nystagmus syndrome: Foveation improvement over a broadened visual fieldJournal of American Association for Pediatric Ophthalmology and Strabismus {JAAPOS}Vol. 11Issue 3PreviewIn reviewing the article by Wang et al,1 I had a considerable number of questions and concerns. Full-Text PDF" @default.
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