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Gräf M, Seliametova L, Hausmann A. [High-dose medialis recession in latent nystagmus]. DIE OPHTHALMOLOGIE 2023; 120:628-632. [PMID: 36471014 DOI: 10.1007/s00347-022-01784-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/28/2022] [Accepted: 11/17/2022] [Indexed: 06/13/2023]
Abstract
BACKGROUND Large muscle recessions reduce anomalous head turn (AHT) in infantile nystagmus syndrome (INS). Their quantitative effect to reduce AHT in fusion maldevelopment nystagmus syndrome (FMNS) is unknown. AIM OF THE STUDY To evaluate the reduction of AHT by large medial rectus muscle recession in patients with FMNS. METHODS We analyzed data of 12 patients with pure FMNS who received large medial rectus muscle recessions on the sound eye or only eye between 2014 and 2019. Medians and ranges (min-max) were: age at surgery 14 years (3-43 years); decimal BCVA sound eye/fellow eye 0.56 (0.4-1.0)/0.01 (0-0.4); AHT at 5 m/0.3 m fixation distance 35° (15-45°)/20° (0-45°); amount of recession 13 mm (11.5-15 mm); follow-up 13 (4-39) months. RESULTS At the final visit, AHT at 5 m/0.3 m was 10° (0-20°/0-15°). The individual reduction of AHT at 5 m amounted to 25° (8-35°) without any overcorrection. The available visual field of functionally monocular patients increased correspondingly. Slight overcorrection at 0.3 m occurred in 2 cases. Adduction of the sound eye was limited to 25e-40°). BCVA and anomalous head posture in vertical and frontal planes did not improve. CONCLUSION Large medial rectus muscle recession on the sound eye improves AHT in FMNS by a similar amount compared to INS and the available visual field of functionally monocular patients.
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Affiliation(s)
- Michael Gräf
- Fachbereich Medizin, Justus-Liebig-Universität Gießen, Gießen, Deutschland.
- Standort Gießen, Universitätsklinikum Gießen und Marburg GmbH, Gießen, Deutschland.
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Gießen und Marburg, Friedrichstr. 18, 35392, Gießen, Deutschland.
| | - Leniie Seliametova
- Standort Gießen, Universitätsklinikum Gießen und Marburg GmbH, Gießen, Deutschland
| | - Anja Hausmann
- Standort Gießen, Universitätsklinikum Gießen und Marburg GmbH, Gießen, Deutschland
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2
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Sharma P. Calming the Visual Storm: Management of Childhood Nystagmus. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2022. [DOI: 10.1055/s-0042-1757889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AbstractChildhood nystagmus creates a visual storm both for the affected child and the treating doctor. This problem occurring in the development phase of the child affects not only the vision but also the general development, if not diagnosed and managed in time. Moreover, some forms may even harbor a neurological tumor needing timely management. First, a brief introduction of nystagmus classification, a simplified approach to diagnose the common childhood nystagmus, and the value of electrophysiology will be presented. Next, the approach to treatment, using a thorough clinical examination, illustrated by patient examples of different types of nystagmus will be presented. The different forms of childhood nystagmus are described: idiopathic infantile nystagmus syndrome (IINS), sensory nystagmus (SN), fusion maldevelopment nystagmus (FMDN), spasmus nutans syndrome (SNS), nystagmus blockage syndrome, periodic alternating nystagmus, and others as well as their specific management. The role of electronystagmography and that of neuroimaging in specific conditions is life saving and is described. The role of auditory biofeedback, acupuncture, medical treatment, and surgical procedures like Augmented Anderson procedure, Hertle-Dell'Osso procedure, supra maximal retro-equatorial recession, and posterior fixation have been elucidated. Newer techniques have simplified the management options and improved the functional outcomes in childhood nystagmus. To conclude, children with nystagmus of types IINS, FMDN, SNS, or SN need to be managed differently. It is thus possible to timely manage these children, not only to save their life and improve their vision but also to improve their living quotient.
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Affiliation(s)
- Pradeep Sharma
- Pediatric and Neuro-Ophthalmology, Centre for Sight, New Delhi, India
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Papageorgiou E, Lazari K, Gottlob I. The challenges faced by clinicians diagnosing and treating infantile nystagmus Part II: treatment. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1970533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Eleni Papageorgiou
- Ulverscroft Eye Unit, Neuroscience, Psychology and Behaviour, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, University of Leicester, Leicester, UK
- Department of Ophthalmology, University Hospital of Larissa, Mezourlo Area, Larissa, Greece
| | - Katerina Lazari
- Department of Ophthalmology, University Hospital of Larissa, Mezourlo Area, Larissa, Greece
| | - Irene Gottlob
- Ulverscroft Eye Unit, Neuroscience, Psychology and Behaviour, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, University of Leicester, Leicester, UK
- Department of Neurology, Cooper University Hospital, Neurological Institute, Camden, New Jersey, USA
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4
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Abstract
In recent years, we have made enormous strides in elucidating the phenomenology of congenital nystagmus. The purpose of this review is to briefly summarize our current understanding of congenital nystagmus in terms of its clinical symptomatology, pathophysiology, differential diagnosis, and ancillary testing, and clinical management. Finally, this discussion provides the reader with an armamentarium of clinical pearls to facilitate diagnosis of the numerous sensory visual disorders that can underlie congenital nystagmus.
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Affiliation(s)
- Michael C Brodsky
- Departments of Ophthalmology and Neurology, Mayo Clinic , Rochester, Minnesota
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Gräf M, Hausmann A, Lorenz B. High-dose Anderson operation for nystagmus-related anomalous head turn. Graefes Arch Clin Exp Ophthalmol 2019; 257:2033-2041. [PMID: 31201488 DOI: 10.1007/s00417-019-04369-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/29/2019] [Accepted: 05/20/2019] [Indexed: 11/28/2022] Open
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.
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Affiliation(s)
- Michael Gräf
- Department of Ophthalmology, Justus-Liebig-University Giessen, Giessen, Germany. .,Universitaetsklinikum Giessen and Marburg GmbH, Campus Giessen, Friedrichstr. 18, 35385, Giessen, Germany.
| | - Anja Hausmann
- Universitaetsklinikum Giessen and Marburg GmbH, Campus Giessen, Friedrichstr. 18, 35385, Giessen, Germany
| | - Birgit Lorenz
- Department of Ophthalmology, Justus-Liebig-University Giessen, Giessen, Germany.,Universitaetsklinikum Giessen and Marburg GmbH, Campus Giessen, Friedrichstr. 18, 35385, Giessen, Germany
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6
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Gravier N. [Etiological assessment of a nystagmus in childhood]. J Fr Ophtalmol 2018; 41:868-878. [PMID: 30361175 DOI: 10.1016/j.jfo.2018.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 04/04/2018] [Indexed: 11/19/2022]
Abstract
Apart from the latent nystagmus, which arises as a consequence of failure to develop binocular vision, every case of childhood nystagmus needs an etiological assessment. Knowledge of the pathogenesis of the various types of nystagmus guides this assessment, particularly considering the morphological characteristics of the nystagmus. The clinical ophthalmologic examination is complemented by OCT and electrophysiologic testing (ERG, VEP). If this testing is normal, an MRI and genetic assessment are required.
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Affiliation(s)
- N Gravier
- Unité de strabologie-polyclinique de l'Atlantique, avenue Claude-Bernard, BP 40419, 44819 Nantes-Saint-Herblain cedex, France.
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7
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Abstract
Nystagmus has a profound impact on patients visual function and social life. Infantile nystagmus (IN) is much more common than neurological nystagmus, and establishing the correct diagnosis is key in guiding the appropriate treatment paradigm. This paper attempts to demonstrate a stepwise approach in investigation and clinical evaluation, that is (often) sufficient in differentiating IN from nystagmus of neurological origin, and to uncover underlying sensory etiologies of IN. Targeted and rational uses of paraclinical exams are emphasized when they deemed necessary to complement the clinical assessment. The author's preferred surgical and non-surgical strategies to optimize vision, and improve the head posture and strabismus that can accompany nystagmus, are discussed (although without the goal of writing a complete revision on the topic).
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Affiliation(s)
- Luis H Ospina
- a Department of Pediatric Ophthalmology and Neuro-Ophthalmology , Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal , Montréal , QC , Canada
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Richards MD, Wong A. Infantile nystagmus syndrome: clinical characteristics, current theories of pathogenesis, diagnosis, and management. Can J Ophthalmol 2016; 50:400-8. [PMID: 26651297 DOI: 10.1016/j.jcjo.2015.07.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/12/2015] [Accepted: 07/22/2015] [Indexed: 11/25/2022]
Abstract
Infantile nystagmus syndrome (INS) is an important clinical diagnosis because it is a common presenting sign of many ocular, neurologic, and systemic diseases. Although INS has been studied for more than a century, its diagnosis and treatment remains a challenge to clinicians because of its varied manifestations and multiple associations, and its pathogenesis continues to rouse considerable scientific debate. Fueled by these challenges, recent basic research and clinical investigations have provided new insights into INS. New genetic discoveries and technological advances in ocular imaging have refined our understanding of INS subtypes and offer new diagnostic possibilities. Unexpected surgical outcomes have led to new understanding of its pathogenesis based on novel hypothesized pathways of ocular motor control. Comparative studies on nonhuman visual systems have also informed models of the neural substrate of INS in humans. This review brings together the classic profile of this disorder with recent research to provide an update on the clinical features of INS, an overview of the current theories on how and why INS develops, and a practical approach to the diagnosis and management of INS.
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Affiliation(s)
- Michael D Richards
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children; Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ont..
| | - Agnes Wong
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children; Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ont
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Oculomotor neurocircuitry, a structural connectivity study of infantile nystagmus syndrome. PLoS One 2015; 10:e0125380. [PMID: 25860806 PMCID: PMC4393090 DOI: 10.1371/journal.pone.0125380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 03/24/2015] [Indexed: 11/19/2022] Open
Abstract
Infantile nystagmus syndrome (INS) is one of the leading causes of significant vision loss in children and affects about 1 in 1000 to 6000 births. In the present study, we are the first to investigate the structural pathways of patients and controls using diffusion tensor imaging (DTI). Specifically, three female INS patients from the same family were scanned, two sisters and a mother. Six regions of interest (ROIs) were created manually to analyze the number of tracks. Additionally, three ROI masks were analyzed using TBSS (Tract-Based Spatial Statistics). The number of fiber tracks was reduced in INS subjects, compared to normal subjects, by 15.9%, 13.9%, 9.2%, 18.6%, 5.3%, and 2.5% for the pons, cerebellum (right and left), brainstem, cerebrum, and thalamus. Furthermore, TBSS results indicated that the fractional anisotropy (FA) values for the patients were lower in the superior ventral aspects of the pons of the brainstem than in those of the controls. We have identified some brain regions that may be actively involved in INS. These novel findings would be beneficial to the neuroimaging clinical and research community as they will give them new direction in further pursuing neurological studies related to oculomotor function and provide a rational approach to studying INS.
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Harrison JJ, Sumner P, Dunn MJ, Erichsen JT, Freeman TCA. Quick phases of infantile nystagmus show the saccadic inhibition effect. Invest Ophthalmol Vis Sci 2015; 56:1594-600. [PMID: 25670485 PMCID: PMC4351650 DOI: 10.1167/iovs.14-15655] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 01/29/2015] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Infantile nystagmus (IN) is a pathological, involuntary oscillation of the eyes consisting of slow, drifting eye movements interspersed with rapid reorienting quick phases. The extent to which quick phases of IN are programmed similarly to saccadic eye movements remains unknown. We investigated whether IN quick phases exhibit 'saccadic inhibition,' a phenomenon typically related to normal targeting saccades, in which the initiation of the eye movement is systematically delayed by task-irrelevant visual distractors. METHODS We recorded eye position from 10 observers with early-onset idiopathic nystagmus while task-irrelevant distractor stimuli were flashed along the top and bottom of a large screen at ±10° eccentricity. The latency distributions of quick phases were measured with respect to these distractor flashes. Two additional participants, one with possible albinism and one with fusion maldevelopment nystagmus syndrome, were also tested. RESULTS All observers showed that a distractor flash delayed the execution of quick phases that would otherwise have occurred approximately 100 ms later, exactly as in the standard saccadic inhibition effect. The delay did not appear to differ between the two main nystagmus types under investigation (idiopathic IN with unidirectional and bidirectional jerk). CONCLUSIONS The presence of the saccadic inhibition effect in IN quick phases is consistent with the idea that quick phases and saccades share a common programming pathway. This could allow quick phases to take on flexible, goal-directed behavior, at odds with the view that IN quick phases are stereotyped, involuntary eye movements.
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Affiliation(s)
| | - Petroc Sumner
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Matt J. Dunn
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Jonathan T. Erichsen
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
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Thomas MG, Crosier M, Lindsay S, Kumar A, Thomas S, Araki M, Talbot CJ, McLean RJ, Surendran M, Taylor K, Leroy BP, Moore AT, Hunter DG, Hertle RW, Tarpey P, Langmann A, Lindner S, Brandner M, Gottlob I. The clinical and molecular genetic features of idiopathic infantile periodic alternating nystagmus. Brain 2011; 134:892-902. [PMID: 21303855 DOI: 10.1093/brain/awq373] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Periodic alternating nystagmus consists of involuntary oscillations of the eyes with cyclical changes of nystagmus direction. It can occur during infancy (e.g. idiopathic infantile periodic alternating nystagmus) or later in life. Acquired forms are often associated with cerebellar dysfunction arising due to instability of the optokinetic-vestibular systems. Idiopathic infantile periodic alternating nystagmus can be familial or occur in isolation; however, very little is known about the clinical characteristics, genetic aetiology and neural substrates involved. Five loci (NYS1-5) have been identified for idiopathic infantile nystagmus; three are autosomal (NYS2, NYS3 and NYS4) and two are X-chromosomal (NYS1 and NYS5). We previously identified the FRMD7 gene on chromosome Xq26 (NYS1 locus); mutations of FRMD7 are causative of idiopathic infantile nystagmus influencing neuronal outgrowth and development. It is unclear whether the periodic alternating nystagmus phenotype is linked to NYS1, NYS5 (Xp11.4-p11.3) or a separate locus. From a cohort of 31 X-linked families and 14 singletons (70 patients) with idiopathic infantile nystagmus we identified 10 families and one singleton (21 patients) with periodic alternating nystagmus of which we describe clinical phenotype, genetic aetiology and neural substrates involved. Periodic alternating nystagmus was not detected clinically but only on eye movement recordings. The cycle duration varied from 90 to 280 s. Optokinetic reflex was not detectable horizontally. Mutations of the FRMD7 gene were found in all 10 families and the singleton (including three novel mutations). Periodic alternating nystagmus was predominantly associated with missense mutations within the FERM domain. There was significant sibship clustering of the phenotype although in some families not all affected members had periodic alternating nystagmus. In situ hybridization studies during mid-late human embryonic stages in normal tissue showed restricted FRMD7 expression in neuronal tissue with strong hybridization signals within the afferent arms of the vestibulo-ocular reflex consisting of the otic vesicle, cranial nerve VIII and vestibular ganglia. Similarly within the afferent arm of the optokinetic reflex we showed expression in the developing neural retina and ventricular zone of the optic stalk. Strong FRMD7 expression was seen in rhombomeres 1 to 4, which give rise to the cerebellum and the common integrator site for both these reflexes (vestibular nuclei). Based on the expression and phenotypic data, we hypothesize that periodic alternating nystagmus arises from instability of the optokinetic-vestibular systems. This study shows for the first time that mutations in FRMD7 can cause idiopathic infantile periodic alternating nystagmus and may affect neuronal circuits that have been implicated in acquired forms.
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Affiliation(s)
- Mervyn G Thomas
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester LE2 7LX, UK
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Fingert JH, Roos B, Eyestone ME, Pham JD, Mellot ML, Stone E. Novel intragenic FRMD7 deletion in a pedigree with congenital X-linked nystagmus. Ophthalmic Genet 2010; 31:77-80. [PMID: 20450309 DOI: 10.3109/13816810903584989] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To identify the disease-causing mutation in a large 3 generation pedigree of X-linked congenital nystagmus. METHODS Twenty-three members of a single pedigree, including 7 affected males, 2 affected females, 5 obligate carriers, and 9 unaffected family members were tested for mutations in the FRMD7 gene using PCR-based DNA sequencing assays and multiplex PCR assays for deletions. RESULTS A hemizygous deletion of exons 2, 3, and 4 of FRMD7 was detected in all affected males in the family and was absent from 40 control subjects. CONCLUSIONS A range of missense, nonsense, frameshift, and splicing mutations in FRMD7 have been shown to cause X-linked congenital nystagmus. Here we show for the first time that large intragenic deletions of FRMD7 can also cause this form of nystagmus.
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Affiliation(s)
- John H Fingert
- Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.
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Hertle RW, Felius J, Yang D, Kaufman M. Eye muscle surgery for infantile nystagmus syndrome in the first two years of life. Clin Ophthalmol 2009; 3:615-24. [PMID: 19997564 PMCID: PMC2788587 DOI: 10.2147/opth.s7541] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Indexed: 11/23/2022] Open
Abstract
Purpose: To report visual and elctrophysioloigcal effects of eye muscle surgery in young patients with infantile nystagmus syndrome (INS). Methods: Prospective, interventional case cohort of 19 patients aged under 24 months who were operated on for combinations of strabismus, an anomalous head posture, and nystagmus. All patients were followed at least nine months. Outcome measures, part of an institutionally approved study, included Teller acuity, head position, strabismic deviation, and eye movement recordings, from which waveform types and a nystagmus optimal foveation fraction (NOFF). Computerized parametric and nonparametric statistical analysis of data were perfomed using standard software on both individual and group data. Results: Age averaged 17.7 months (13.1-month follow-up). Thirteen (68%) patients had associated optic nerve or retinal disease. 42% had amblyopia, 68% had refractive errors. Group means in binocular Teller acuity (P < 0.05), strabismic deviation (P < 0.05), head posture (P < 0.001), and the NOFF measures (P < 0.01) from eye movement recordings improved in all patients. There was a change in null zone waveforms to more favorable jerk types. There were no reoperations or surgical complications. Conclusions: Surgery on the extraocular muscles in patients aged less than two years with INS results in improvements in multiple aspects of ocular motor and visual function.
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Affiliation(s)
- Richard W Hertle
- The UPMC and Children's Hospital of Pittsburgh Eye Centers and The Laboratory of Visual and Ocular Motor Physiology Pittsburgh, PA, USA.
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15
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Abstract
In preverbal children, it is difficult to assess visual acuity accurately. If nystagmus waveforms can be used to predict visual acuity in these young patients, then they would be a useful additional clinical tool. Existing acuity predictors were assessed in 10 adults with idiopathic early onset nystagmus. The most reliable predictor in this group of patients was mean velocity of the waveform. The mean velocity of the waveform may be used in preverbal children to give an estimate of best potential visual acuity in adulthood, and estimated best potential visual acuity at the current age.
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Affiliation(s)
- Maria Theodorou
- Visual Sciences Unit, Institute of Child Health, University College London, London WC1N 1EH, UK.
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16
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Abstract
Involuntary occular oscillations in infancy and childhood can be understood, diagnosed, classified and treated as a result of modern electrophysiology and neuroanatomical knowledge.
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Affiliation(s)
- Richard W Hertle
- The UPMC and The Children's Hospital of Pittsburgh Eye Centers, Laboratory of Visual and Ocular Motor Physiology, Pittsburgh, PA 15213, USA.
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17
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Abstract
BACKGROUND This study identifies the clinical and ocular motility characteristics of the periodic and aperiodic forms of infantile alternating nystagmus (IAPAN) and establishes the range of electrophysiological and clinical characteristics while providing clues to its presence and pathophysiology. METHODS Seventy-eight patients with ocular oscillations consistent with IAPAN were reported. Outcome variables were: age, follow-up in months, vision, strabismus, other eye and systemic abnormalities, head position, periodicity, cycle and null period duration, foveation time, waveforms, and cycle symmetry. RESULTS Age range was 1 to 67 years, 50% had pure periodic and aperiodic forms, 46% had albinism, 26% had binocular acuity of 20/40 or greater, 72% had strabismus, 35% had amblyopia, 31% had other eye disease, 14% had systemic disease, 87% had an anomalous head posture, and 65% had binocular directional asymmetry. The periodic cycle averaged 224 seconds and the aperiodic cycle ranged from 2 to more than 300 seconds. One in three patients with strabismus and nystagmus periodicity had a static head posture. CONCLUSION Fifteen percent of the infantile nystagmus syndrome population had either the periodic or aperiodic form. A changing null period is often clinically missed because of long or irregular cycles, decreased acuity, associated strabismus, and either a nonexistent or inconsistent head posture. The changing null period is easier to recognize using eye movement recordings or if the non-preferred eye is occluded and the preferred eye is examined with the head straight and gaze in primary position for at least 5 to 7 minutes. The recognition of this variant has profound treatment implications.
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Affiliation(s)
- Richard W Hertle
- Division of Ophthalmology, Children's Hospital of Pittsburgh, 3705 Fifth Ave., Pittsburgh, PA 15213, USA
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Hertle RW, Yang D. Clinical and electrophysiological effects of extraocular muscle surgery on patients with Infantile Nystagmus Syndrome (INS). Semin Ophthalmol 2006; 21:103-10. [PMID: 16702078 DOI: 10.1080/08820530600614249] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this report is to summarize clinical and electrophysiological effects of extraocular muscle surgery in patients with INS. Our hypothesis is that surgery on the extraocular muscles of patients with INS changes their nystagmus resulting in improved vision and visual functions. All patients had all four virgin horizontal recti operated on, either for strabismus alone, nystagmus alone, for a head posture due to an eccentric null zone alone or for a head posture due to an eccentric null zone plus strabismus. All patients have been followed for at least 12 months. Subjective outcome measures include the pre- and post-operative binocular best optically corrected null zone acuity (NZA) in 75 patients and gaze dependent acuity (GDA) in 12 patients. Objective outcome measure included null zone width (NZW) in 75 patients. The results are summarized as follows: NZA increased .1 LogMar or greater in 75% with those patients <or=8 years significantly better. Subjective GDA and NZW measured from eye movement recordings showed persistent, significant increases. This report adds to the evidence that surgery on the extraocular muscles in patients with INS has independent neurological and visual results, from simply reposition the head, eye(s) or visual axis.
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Affiliation(s)
- Richard W Hertle
- The Division of Ophthalmology, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, PA 15213, USA.
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Zhang B, Xia K, Ding M, Liang D, Liu Z, Pan Q, Hu Z, Wu LQ, Cai F, Xia J. Confirmation and refinement of a genetic locus of congenital motor nystagmus in Xq26.3-q27.1 in a Chinese family. Hum Genet 2004; 116:128-31. [PMID: 15517395 DOI: 10.1007/s00439-004-1188-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2004] [Accepted: 08/26/2004] [Indexed: 10/26/2022]
Abstract
Congenital motor nystagmus (CMN), a subtype of nystagmus, may reduce vision or be associated with other, more serious, conditions that limit vision. The genetic basis for CMN is still unknown. To identify a locus for CMN, genotyping and linkage analysis were performed in 22 individuals from a Chinese family with X-linked CMN using markers from X chromosome. The maximum LOD score obtained for microsatellite maker DXS1192 linked the CMN locus in this family to Xq. By haplotype construction the locus for CMN was finally localized to an approximately 4.4-cM region at chromosome Xq26.3-q27.1. The SLC9A6 and FGF13 genes in this region, were selected and screened for mutation in this family, but no mutation was detected.
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Affiliation(s)
- Baorong Zhang
- Department of Neurology of Second Hospital, Affiliated Zhejiang University, 310009 Hangzhou, China.
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Stevens DJ, Hertle RW. Relationships between visual acuity and anomalous head posture in patients with congenital nystagmus. J Pediatr Ophthalmol Strabismus 2003; 40:259-64; quiz 297-8. [PMID: 14560831 DOI: 10.3928/0191-3913-20030901-04] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine whether patients with congenital nystagmus and an anomalous head posture have better binocular visual acuity than such patients without an anomalous head posture. PATIENTS AND METHODS This was an observational case series of prospectively collected data for 125 patients with clinical and oculographically confirmed congenital nystagmus. Clinical data were tabulated using computer software. Statistical analyses compared binocular visual acuity with and without the presence of a clinically evident anomalous head posture and visual acuity with and without associated sensory disease. RESULTS The mean visual acuity was 20/42 (log of the minimal angle of resolution [MAR], 0.32) in patients with an anomalous head posture and 20/83 (logMAR, 0.62) in patients with no anomalous head posture (P < .001). Among patients with disease of the sensory system, those with an anomalous head posture had a mean visual acuity of 20/55 (logMAR, 0.44) and those without an anomalous head posture had a mean visual acuity of 20/108 (logMAR, 0.73; P < .001). CONCLUSIONS Visual acuity was found to be significantly better in patients with congenital nystagmus who had an anomalous head posture versus those without such a head posture. Our findings indicate that the presence of an anomalous head posture in a patient with congenital nystagmus correlates with good vision and thus may be considered a positive prognostic sign in a preverbal child.
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Affiliation(s)
- Deanna J Stevens
- Laboratory of Visual and Ocular Motor Physiology and the Department of Ophthalmology, Columbus Children's Hospital, Columbus, Ohio, USA
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Hertle RW, FitzGibbon EJ, Avallone JM, Cheeseman E, Tsilou EK. Onset of oscillopsia after visual maturation in patients with congenital nystagmus. Ophthalmology 2001; 108:2301-7; discussion 2307-8. [PMID: 11733274 DOI: 10.1016/s0161-6420(01)00815-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To describe the clinical and oculographic characteristics of a cohort of five patients with congenital nystagmus (CN) and late-onset oscillopsia caused by a coincidental decline in other visual and/or ocular motor functions. DESIGN Retrospective, observational, case series. PARTICIPANTS Five visually mature patients with CN and recent-onset oscillopsia were evaluated clinically and with motility recordings. INTERVENTION Eye movement analysis was performed off-line by computer analysis of digitized data. Nystagmus was analyzed for null-zone characteristics, waveforms, frequency, amplitudes, and slow-phase drift velocity during foveation. Surgical and medical treatment of associated ocular conditions in four of five patients. MAIN OUTCOME MEASURES Presence of symptomatic oscillopsia and average time during foveation periods of slow-phase drift velocity less than 10 degrees /second. RESULTS One of the five patients had associated rod-cone dystrophy, and another had recurrence of childhood head posturing with return of an eccentric null zone. The remaining three patients had decompensated strabismus associated with their oscillopsia. All five patients complained of oscillopsia in primary position that was relieved in the four who received treatment. Treatment included prismatic correction in one patient and surgery in three. Recordings in primary position after treatment showed increased duration during foveation periods of slow-phase drift velocity less than 10 degrees /second and an overall decreased intensity (amplitude/frequency) of the nystagmus. CONCLUSIONS Symptomatic oscillopsia in patients with CN is unusual. This visually disturbing symptom can be precipitated by new or changing associated visual sensory conditions (e.g., decompensating strabismus, retinal degeneration). If the associated conditions can be treated, then accompanying oscillopsia may be relieved.
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Affiliation(s)
- R W Hertle
- Laboratory of Sensorimotor Research, The National Eye Institute, The National Institutes of Health, Building 49 Room 2A50, Bethesda, MD 20892, USA
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Abstract
Although electronystagmography is most useful, especially in furthering our knowledge of nystagmus, simple clinical study is the first step to any understanding of nystagmus. Ophthalmologists should be aware that they may understand a good deal about nystagmus merely by studying visual acuity in their surgery. Testing visual acuity at distance with both eyes open will lead to the qualitative and quantitative diagnosis of compensatory abnormal head postures. Testing at distance with 1 eye covered will help to distinguish between the concordant head turn, one eye fixing in abduction and the other fixing in adduction (ABD + ADD) as manifest congenital nystagmus, and the discordant head turn in which each eye fixes in adduction (ADD + ADD), as is seen in manifest latent nystagmus, for which surgery is totally different. Pseudolatent nystagmus found in congenital nystagmus with exophoria can be differentiated from latent nystagmus. This illustrates de visu (with the naked eye) the "beauty" of the movement of blocking fusional convergence and the nature of the involved mechanisms with artificial divergence surgery. Testing at near will bring out the existence of blocking convergence. Depending on the results, the clinical rationale for surgery is thus made clear: horizontal, vertical, rotatory Kestenbaum-like surgery should be used in cases of abnormal head posture, whereas artificial divergence surgery is our most satisfactory armamentarium in cases of blocking convergence.
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