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Retrospective study of recession of four horizontal rectus muscle in periodic alternating nystagmus

Authors Mimura O, Ishikawa H, Kimura N, Kimura A, Borlongan C

Received 6 August 2014

Accepted for publication 1 October 2014

Published 11 December 2014 Volume 2014:8 Pages 2523—2528


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Scott Fraser

Supplemental video showing nystagmus "after" surgery in case number 1

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Osamu Mimura,1 Hiroto Ishikawa,1,2 Naoki Kimura,1 Akiko Kimura,1 Cesar V Borlongan2

1Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; 2Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA

Periodic alternating nystagmus (PAN) is a spontaneous horizontal nystagmus observed in disorders of the central nervous system. Patients with congenital PAN complain of oscillating vision at high rates. Medication is the first-choice treatment for PAN; however, clinicians still seek better therapy. The aim of this study was to evaluate outcomes of recession of four horizontal rectus muscle (R-FHR) in patients with congenital PAN.
Patients and methods: This study reports a retrospective case series of ten patients (seven males and three females; mean age 24.4±10.9) with congenital PAN who underwent R-FHR between 2007 and 2012, which was performed by the same surgeon at the Hyogo College of Medicine. Patients were evaluated for complications, recession amount, deviation angle, eye movements including a nystagmus amplitude, and visual acuity during pre- and post-operative periods.
Results: Pre-operatively, patients complained of oscillating vision, abnormal head posture, esotropia, and congenital superior oblique palsy. Post-operatively, changes from the previous observations of nystagmus amplitudes and abnormal head posture demonstrated a complete reversal in all patients. In addition, visual acuity determined with a Snellen chart improved in two patients. However, esotropia occurred in three patients who underwent additional strabismus surgery 2 days after R-FHR. R-FHR was particularly effective in eight patients who pre-operatively had periodic oscillating vision with a regular pattern of periodic nystagmus.
Conclusion: We demonstrated that ten patients with congenital PAN had improved vision following R-FHR, indicating that R-FHR was an effective procedure, especially in patients suffering PAN with periodic oscillating vision.

congenital nystagmus, null point nystagmus, strabismus surgery, ocular torticollis, oscillating vision, electro-oculogram

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