Laser in situ keratomileusis in myopic patients with congenital nystagmus

Small-incision lenticule extraction in a patient with congenital nystagmus

We report a case of a 23-year-old woman with congenital nystagmus who had small-incision lenticule extraction (SMILE) procedure to correct refractive errors. The manifest refraction was -5.50 -1.75 × 180 in the right eye, -5.0 -2.50 × 180 in the left eye, and the patient presented with horizontal pendular nystagmus with an amplitude range of 5 to 10 degrees. Uneventful simultaneous bilateral small-incision lenticule extraction was performed. Six months postoperatively, the uncorrected distance visual acuity was 20/18 with -0.25, -0.25 × 80 in the right eye, and 20/20 with +0.25 -0.5 × 50 in the left eye. The case suggests that small-incision lenticule extraction can be an effective alternative for correcting myopic astigmatism in patients with nystagmus.

Effect of Photorefractive Keratectomy on Nystagmus and Visual Functions in Myopic Patients With Infantile Nystagmus Syndrome

PURPOSE

To determine the effect of photorefractive keratectomy (PRK) on involuntary eye movements, visual acuity, and contrast sensitivity in myopic patients with infantile nystagmus syndrome.

DESIGN

Prospective interventional case series.

METHODS

This study was conducted on patients with infantile nystagmus syndrome and myopia equal to or more than -1 diopter (D), who were referred to our clinic over a 2-year period. Patients older than 18 years of age with a stable refraction for at least 1 year who were good candidates for PRK were included. Complete ophthalmologic examinations including assessment of best-corrected visual acuity (BCVA), contrast sensitivity, and videonystagmography were performed for all patients before and 3 months after surgery.

RESULTS

Twenty-four eyes of 12 patients with mean age of 23 ± 2 years were enrolled in this study. Spherical equivalent refractive error was -2.82 ± 1.65 D and -0.26 ± 0.25 D before and after PRK, respectively (P < .001). Monocular BCVA improved from 0.36 ± 0.21 logMAR to 0.27 ± 0.25 logMAR and binocular BCVA improved from 0.33 ± 0.2 logMAR to 0.17 ± 0.16 logMAR (P < .001). Contrast sensitivity significantly improved at low (P < .001), intermediate (P < .001), and high frequencies (P = .01). The frequency, amplitude, and intensity of nystagmus were significantly decreased after PRK (P < .001). There was no correlation between the degree of myopia correction and improvement in sensory and motor indices of nystagmus (P > .1, Spearman correlation coefficient).

CONCLUSION

PRK in patients with infantile nystagmus syndrome and myopia improved monocular and binocular BCVA and contrast sensitivity. Furthermore, motor indices of nystagmus (frequency, amplitude, and intensity) were significantly improved after surgery in these patients.

Artiflex toric phakic intraocular lens implantation in congenital nystagmus

CASE

A 44-year-old woman with congenital nystagmus and myopic astigmatism in both eyes who was submitted to phakic intraocular lens (pIOL) implantation.

METHODS

Full ophthalmologic examination including refractive status, corrected (CDVA) and uncorrected (UCVA) monocular and binocular visual acuities, ocular motility, slit-lamp evaluation, tonometry and fundoscopy before and after implantation of toric pIOLs (Artiflex; Ophtec BV, The Netherlands) in both eyes.

RESULTS

Preoperative logMAR CDVA were 0.699 and 0.420 in the right and left eye, respectively. Three months after surgery, logMAR UCVA were 0.398 and 0.182, reaching binocular logMAR UCVA of 0.132. There were no changes in nystagmus characteristics after surgery.

CONCLUSIONS

pIOL implantation may be a safe and suitable treatment to correct high refractive errors in patients with congenital nystagmus. Significant improvement in CDVA and UCVA can be achieved.