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Richard W Hertle, Ashraf Ahmad; Clinical and Electrophysiological Results of Eye Muscle Surgery in 17 Patients with Downbeat Nystagmus (DBN). Invest. Ophthalmol. Vis. Sci. 2017;58(8):863.
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© ARVO (1962-2015); The Authors (2016-present)
The purpose of this report is to characterize the clinical characteristics and visual system changes of patients with DBN before and after eye muscle surgery.
This is a prospective, case series of 17 patients with DBN before and at least 2 months after eye muscle surgery. Eye muscle surgery consisted of bilateral superior rectus recession and bilateral inferior oblique myectomy in all patients for the nystagmus and standard additional rectus surgery for any associated strabismus. Outcome measures included, subjective oscillopsia (SO), strabismic deviation (SD) using standard alternate prism/cover, head posture (AHP) using a Cervical Range Of MotionR device and best binocular acuity (BVA) using standardized acuity testing, nystagmus function (NF) using eye movement recordings and contrast sensitivity (CS) using the CSV1000R device in primary position.
Ages ranged from 5-85 yrs (ave 27 yrs), 59% male, follow up ranged from 1-10 years (ave 2 yrs). 14 (82%) had diagnosed CNS disease, 15 (88%) had a clinical AHP, 6 (35%) had other eye diseases, 9 (53%) had associated strabismus and all had oscillopsia and/or decreased BVA and CS compared to normal for age. After eye muscle surgery there were significant, persistent group improvements in NF, BVA, AHP, SD, CS, and SO after surgery (P< .0012 to < 0.05). Those will alcohol related CNS disease responded the least to surgery while children (<18 years) improved the most. Two patients required reoperation for a consecutive strabismus. There were no serious complications.
DBN patients commonly have associated central nervous system abnormalities and may be offered standard eye muscle surgery in addition to known medical treatments to improve associated abnormal visual system signs and symptoms.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Eye movement recording of patient 11 before (figure left) and after (figure right) eye muscle surgery showing globally decreased changes in intesity in the vertical component of the DBN oscillation when looking between right 20 degrees and left 20 degrees.
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