September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
The Role of Superior Oblique Posterior Tenectomy Combined with Inferior Rectus Recession for the Treatment of Chin Up Head Positioning in Patients with Nystagmus
Author Affiliations & Notes
  • Anna G Escuder
    Ophthalmology, NYU Langone Medical Center , New York, New York, United States
  • Milan P Ranka
    Ophthalmology, NYU Langone Medical Center , New York, New York, United States
    Pediatric Ophthalmic Consultants, New York, New York, United States
  • Kathy Lee
    Pediatric Ophthalmic Consultants, New York, New York, United States
  • Julie N Nam
    Ophthalmology, NYU Langone Medical Center , New York, New York, United States
    Pediatric Ophthalmic Consultants, New York, New York, United States
  • Mark A Steele
    Ophthalmology, NYU Langone Medical Center , New York, New York, United States
    Pediatric Ophthalmic Consultants, New York, New York, United States
  • Footnotes
    Commercial Relationships   Anna Escuder, None; Milan Ranka, None; Kathy Lee, None; Julie Nam, None; Mark Steele, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 2462. doi:
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    • Get Citation

      Anna G Escuder, Milan P Ranka, Kathy Lee, Julie N Nam, Mark A Steele; The Role of Superior Oblique Posterior Tenectomy Combined with Inferior Rectus Recession for the Treatment of Chin Up Head Positioning in Patients with Nystagmus. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2462.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To evaluate the clinical outcomes of bilateral superior oblique (SO) posterior 7/8th tenectomy along with inferior rectus recession on improving chin up head positioning in patients with nystagmus.

Methods : Medical records were reviewed from 2007-2015 for patients with chin up head positioning in the presence of nystagmus with null point in downgaze without history of previous eye muscle surgery, who underwent combined bilateral SO posterior 7/8th tenectomy (Figure 1) with inferior rectus recession of at least 5.0mm.

Results : Nine patients met the inclusion criteria and were evaluated in our study. The average age of the patients was 5.0 years (median 4.0 years, range 1-14.3), including seven males and two females. Chin up positioning ranged from 15 to 45 degrees (average 29.4 degrees, median 30 degrees). Seven of the patients also underwent simultaneous horizontal muscle surgery. All patients had improvement in their chin up head positioning at both the initial postoperative visit and the most recent follow up (Figure 2). Three patients developed intermittent face turns, one of which required horizontal Anderson Procedure two years after initial surgery with resolution. Three patients had mild intermittent chin up positioning at their most recent follow up, however overall improved from preoperative assessment. No postoperative pattern deviations or evidence of inferior oblique overaction were seen. The average follow up time was 32 months. No surgical complications were noted.

Conclusions : Bilateral superior oblique posterior 7/8th tenectomy in conjunction with bilateral inferior rectus recession is a safe and effective procedure for improving chin up head positioning in nystagmus patients with their null point in downgaze.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Figure 1A: Initial posterior 7/8th incision of the SO tendon. 1B: Intact anterior 1/8th torsional fibers of SO tendon.

Figure 1A: Initial posterior 7/8th incision of the SO tendon. 1B: Intact anterior 1/8th torsional fibers of SO tendon.

 

Figure 2A: Preoperative chin up head posturing. 2B: Postoperative head posturing.

Figure 2A: Preoperative chin up head posturing. 2B: Postoperative head posturing.

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