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R.T. Sebastian, I.B. Marsh; Heimann–Bielscholwsky Phenomenon: Vertical Recti Recession Gives Good Cosmetic Results in Patients With Large Amplitude Vertical Nystagmoid Movements . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2942.
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Heimann–Bielscholwsky phenomenon (HBP) is an uniocular vertical nystagmoid pattern which typically occurs in an eye with profound visual loss due to congenital or, more commonly acquired causes. We describe four cases of HBP with large amplitude vertical oscillations that had good cosmetic results following superior rectus muscle recession with or without inferior rectus recession.
Four patients, referred to a strabismologist over a three–year period with vertical nystagmoid pattern and profound visual loss. All but one had acquired causes for vision loss. All had vertical oscillations and large vertical amplitudes with a range of 14–20 prism dioptres. These patients were investigated and underwent recession of the one or both vertical recti attaining good results (range: 0–3 prism dioptres).
Mean age was 36.3 years (Range:4–50 years). Patient 1 underwent superior rectus (SR) recession initially and a further inferior rectus recession nine months later. Only one patient had an accompanying esotropia and awaiting surgical correction. All the patients had good cosmetic results following surgery. Details of surgery and outcome have been described in Table1.
The amplitude of deviation in HBP is often small with the oscillations varying between 1–5 seconds per cycle. Cosmetically unacceptable amplitudes of 40–60 PD can develop in young patients with high grade amblyopia and in some neurological diseases. The majority of patients with HBP have accompanying strabismus but only one of the cases in our series had esotropia.
Faden operation of vertical recti has reported improved symptoms in some cases though it is unlikely to be of functional benefit. Our series show that in patients with HBP associated large amplitude deviation and vertical nystagmoid movements, recession of the superior rectus muscle alone or in combination with inferior rectus recession gives good cosmetic results.
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