Abstract
Purpose
To evaluate the effectiveness of a high-dose Anderson procedure (AP) to correct infantile nystagmus–related anomalous head turn (HT).
Methods
Twenty-nine consecutive orthotropes with infantile nystagmus with and without associated sensory defect received high-dose AP. HT was measured while the patient tried to read letters at best-corrected visual acuity (BCVA) level at 5 m and 0.3 m. BCVA, binocular vision (BV), and alignment (prism and cover test) were measured. High-dose AP with recessions of 9–16 mm was performed. All measures were taken before and 3–6 and ≥ 8 months post surgery. Success was defined by postoperative HT ≤ 10°/HT ≤ 15°.
Results
Medians and ranges (minimum-maximum) were:. Age at surgery was 7 years (4–44). HT at 5 m and HT at 0.3 m were 35° (20–40) and 20° (0–35), respectively. After 4 months (3–6), HT was 10° (− 3–20) and 5° (− 5–20); success rates were 74%/96% and 83%/96%. After 15 months (8–45), HT was 12° (0–20) and 6° (0–15); success rates were 46%/75% and 92%/100%; residual HT > 15° occurred in 5/9 cases with recessions < 13 mm and 1/15 cases with recessions ≥ 13 mm. With recessions ≥ 13 mm, 60% (95% confidence intervals (C.I.), 33–83%) achieved HT ≤ 10° and 93% (95% C.I. 66–99%) achieved HT ≤ 15°. Overcorrection did not occur. Anomalous head posture components in vertical and frontal planes did not improve. Residual motility was 30° (10–45). The mean BCVA improved by only 0.037 logMAR (p = 0.06). BV and ocular alignment were constant, except in 2 patients whose exophoria decompensated.
Conclusions
Kestenbaum surgery is a common procedure to correct infantile nystagmus–related HT. Anderson surgery is confined to bilateral yoke muscle recession; hence, less invasive but nevertheless comparably effective, high dosage is provided.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00417-019-04369-0/MediaObjects/417_2019_4369_Fig1_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00417-019-04369-0/MediaObjects/417_2019_4369_Fig2_HTML.png)
Similar content being viewed by others
References
Kestenbaum A (1953) Une nouvelle opération du nystagmus. Bull Soc Ophtalmol Fr 6:599–602
Kestenbaum A (1954) A nystagmus operation. Acta Concil Ophthalmol 2:1071–1078
Cooper EL, Sandall GS (1969) Surgical treatment of congenital nystagmus. Arch Ophthalmol 81:473–480
Calhoun JH, Harley RD (1973) Surgery for abnormal head position in congenital nystagmus. Trans Am Ophthalmol Soc 71:70–87
Parks MM (1973) Congenital nystagmus surgery. Am Orthoptic J 23:35–39
Taylor JN (1973) Surgery for horizontal nystagmus—Anderson-Kestenbaum operation. Aust J Ophthalmol 1:114–116
Kommerell G (1974) Surgical management of altered head posture in patients with congenital nystagmus [in German]. Klin Monatsbl Augenheilkd 164:172–191
Nelson LB, Ervin-Mulvery LD, Calhoun JH et al (1984) Surgical management for abnormal head position in nystagmus. The augmented modified Kestenbaum procedure. Br J Ophthalmol 68:796–800
Scott WE, Kraft SP (1984) Surgical treatment of compensatory head position in congenital nystagmus. J Pediatr Ophthalmol Strabismus 21:85–95
Mitchell PR, Wheeler MR, Parks MM (1987) Kestenbaum surgical procedure for torticollis secondary to congenital nystagmus. J Pediatr Ophthalmol Strabismus 24:87–93
Pratt-Johnson JA (1991) Results of surgery to modify the null-zone position in congenital nystagmus. Can J Ophthalmol 26:219–223
Lee IS, Lee JB, Kim HS et al (2000) Modified Kestenbaum surgery for correction of abnormal head posture in infantile nystagmus: outcome in 63 patients with graded augmentation. Binocul Vis Strabismus Q 15:53–58
Gräf M, Droutsas K, Kaufmann H (2001) Kestenbaum surgery and artificial divergence for nystagmus related head turn. Graefe’s Arch Clin Exp Ophthalmol 239:334–341
Cüppers C (1971) Problems in the surgery for ocular nystagmus [in German]. Klin Monatsbl Augenheilkd 159:145–157
Kaufmann H, Kolling G (1981) Operative Behandlung bei Nystagmuspatienten mit Binokularfunktionen mit und ohne Kopfzwangshaltung. Ber Dtsch Ophthalmol Ges 78:815–819
Roggenkämper P (1984) Combination of artificial divergence with Kestenbaum operation in cases of torticollis caused by nystagmus. In: Reinecke RD (ed) Strabismus II. Grune and Stratton, Orlando, pp 329–334
Sendler S, Shallo-Hoffmann J, Mühlendyck H (1990) Artificial divergence surgery in congenital nystagmus [in German]. Fortschr Ophthalmol 87:85–89
Zubcov AA, Reinecke RD, Gottlob I et al (1990) Treatment of manifest latent nystagmus. Am J Ophthalmol 110:160–167
Anderson JR (1953) Causes and treatment of congenital eccentric nystagmus. Br J Ophthalmol 37:267–281
GK v N, Campos E (2002) Binocular vision and ocular motility. Theory and management of strabismus. Mosby, St. Louis, pp 522–523
Repka MX (2004) Nystagmus surgery. In Plager DA (ed) Strabismus surgery: basic and advanced strategies. In: Parrish R (ed) Ophthalmology monographs. American Academy of Ophthalmology Monograph Series. Oxford University Press, New York, pp 155–167
de Decker W (1987) Kestenbaum transposition in nystagmus therapy. Transposition in horizontal and torsional plane. Bull Soc Belge Ophtalmol 221(222):107–120
Garcia-Guzman G, Washington R, Villaseñor J (1990) Anderson’s surgery [in Spanish]. Rev Mex Oftalmol 64:183–186
Arroyo-Yllanes ME, Fonte-Vázquez A, Pérez-Pérez JF (2002) Modified Anderson procedure for correcting a normal mixed head position in nystagmus. Br J Ophthalmol 86:267–269
Gupta R, Sharma P, Menon V (2006) Prospective clinical evaluation of augmented Anderson procedure for idiopathic infantile nystagmus. J AAPOS 10:312–317
Teodorescu LA, Cioplean DE, Dragomir M, Velcea I (2008) Surgical options in congenital nystagmus (Ny). In: Gomez de Liano R, ed. Transactions 32nd Meeting European Strabismological Association, Munich, September 2008, pp 285–288
Gräf M, Lorenz B (2016) Indication and results of the Anderson procedure[in German]. Klin Monatsbl Augenheilkd 233:1115–1119
Reinecke RD (1997) Idiopathic infantile nystagmus: diagnosis and treatment. J AAPOS 1:67–82
Hald A (1952) Statistical theory with engineering applications. John Wiley & Sons, London, pp 697–700
Kumar A, Shashikant S, Vijayalakshmi P, Hertle R (2011) Improvement in visual acuity following surgery for correction of head posture in infantile nystagmus syndrome. J Pediatr Ophthalmol Strabismus 48:341–346
Schild AM, Thoenes J, Fricke J, Neugebauer A (2013) Kestenbaum procedure with combined muscle recession and tucking for nystagmus-related head turn. Graefes Arch Clin Exp Ophthalmol 251:2803–2809
Sternberg-Raáb A (1963)Anderson-Kestenbaum operation for asymmetrical gaze nystagmus. Br J Ophthalmol 47:339–345
Metzger EL (1950) Correction of congenital nystagmus. Am J Ophthalmol 33:1796–1797
Lorenz B, Gampe E (2001) Analysis of 180 patients with sensory defect nystagmus (SDN) and congenital idiopathic nystagmus (CIN) [in German]. Klin Monatsbl Augenheilkd 218:3–12
Bertsch M, Floyd M, Kehoe T et al (2017) The clinical evaluation of infantile nystagmus: what to do first and why. Ophthalmic Genet 38:22–33
Bietti GB, Bagolini B (1960) Traitement médicochirurgical du nystagmus. Ann Ther Clin Ophtalmol 11:269–296
Noorden GK, Sprunger DT (1991) Large rectus muscle recessions for the treatment of congenital nystagmus. Arch Ophthalmol 109:221–224
Helveston EM, Ellis FD, Plager DA (1991) Large recession of the horizontal recti for treatment of nystagmus. Ophthalmology 98:1302–1305
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. The study was approved by the local institutional board of the Justus-Liebig-University (PN 130/15).
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Gräf, M., Hausmann, A. & Lorenz, B. High-dose Anderson operation for nystagmus-related anomalous head turn. Graefes Arch Clin Exp Ophthalmol 257, 2033–2041 (2019). https://doi.org/10.1007/s00417-019-04369-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-019-04369-0