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Effects of tenotomy on patients with infantile nystagmus syndrome: foveation improvement over a broadened visual field.
J AAPOS. 2006 Dec; 10(6):552-60.JA

Abstract

PURPOSE

To investigate the effects of four-muscle tenotomy on visual function and gaze angle in patients with infantile nystagmus syndrome (INS).

METHODS

Eye movements of nine patients with infantile nystagmus were recorded using infrared reflection or high-speed digital video techniques. Experimental protocols were designed to record the patients' eye-movement waveforms, pre- and post-tenotomy, at different gaze angles. We used the eXpanded Nystagmus Acuity Function (NAFX) to measure tenotomy-induced changes in the nystagmus at primary position and various gaze angles. The longest foveation domains (LFD) were measured from fitted curves. Peak-to-peak nystagmus amplitudes and foveation-period durations were also measured. All measurements were made unmasked.

RESULTS

All seven patients with narrow, high-NAFX, gaze-angle regions showed broadening of these regions of higher visual function. Three patients showed moderate NAFX improvement (13.9-32.6%) at primary position, five showed large improvement (39.9-162.4%), and one showed no NAFX change (due to his high pretenotomy NAFX). Primary position measured acuities improved in six patients. All patients had reductions in nystagmus amplitudes ranging from 14.6 to 37%. The duration of the foveation period increased in all nine patients (11.2-200%). The percentage improvements in both the NAFX and the LFD decreased with higher pretenotomy values.

CONCLUSIONS

In addition to elevating primary position NAFX, tenotomy also broadens the high-NAFX regions. This broadening effect is more prominent in patients who had sharp pretenotomy NAFX peaks. Four-muscle tenotomy produces higher primary position NAFX increases in infantile nystagmus patients whose pretenotomy values are relatively low, with the improvement decreasing at higher pretenotomy values. The tenotomy procedure improves visual function beyond primary position acuity. This extends the utility of surgical therapy to several different classes of patients with INS for whom other procedures are contraindicated. The pretenotomy NAFX can now be used to predict both primary position acuity improvements and broadening of a patient's high-NAFX range of gaze angles.

Authors+Show Affiliations

Daroff-Dell'Osso Ocular Motility Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio 44106, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

17189150

Citation

Wang, Zhong, et al. "Effects of Tenotomy On Patients With Infantile Nystagmus Syndrome: Foveation Improvement Over a Broadened Visual Field." Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus, vol. 10, no. 6, 2006, pp. 552-60.
Wang Z, Dell'Osso LF, Jacobs JB, et al. Effects of tenotomy on patients with infantile nystagmus syndrome: foveation improvement over a broadened visual field. J AAPOS. 2006;10(6):552-60.
Wang, Z., Dell'Osso, L. F., Jacobs, J. B., Burnstine, R. A., & Tomsak, R. L. (2006). Effects of tenotomy on patients with infantile nystagmus syndrome: foveation improvement over a broadened visual field. Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus, 10(6), 552-60.
Wang Z, et al. Effects of Tenotomy On Patients With Infantile Nystagmus Syndrome: Foveation Improvement Over a Broadened Visual Field. J AAPOS. 2006;10(6):552-60. PubMed PMID: 17189150.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of tenotomy on patients with infantile nystagmus syndrome: foveation improvement over a broadened visual field. AU - Wang,Zhong, AU - Dell'Osso,Louis F, AU - Jacobs,Jonathan B, AU - Burnstine,Robert A, AU - Tomsak,Robert L, PY - 2004/06/05/received PY - 2004/08/21/accepted PY - 2006/12/26/pubmed PY - 2007/2/16/medline PY - 2006/12/26/entrez SP - 552 EP - 60 JF - Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus JO - J AAPOS VL - 10 IS - 6 N2 - PURPOSE: To investigate the effects of four-muscle tenotomy on visual function and gaze angle in patients with infantile nystagmus syndrome (INS). METHODS: Eye movements of nine patients with infantile nystagmus were recorded using infrared reflection or high-speed digital video techniques. Experimental protocols were designed to record the patients' eye-movement waveforms, pre- and post-tenotomy, at different gaze angles. We used the eXpanded Nystagmus Acuity Function (NAFX) to measure tenotomy-induced changes in the nystagmus at primary position and various gaze angles. The longest foveation domains (LFD) were measured from fitted curves. Peak-to-peak nystagmus amplitudes and foveation-period durations were also measured. All measurements were made unmasked. RESULTS: All seven patients with narrow, high-NAFX, gaze-angle regions showed broadening of these regions of higher visual function. Three patients showed moderate NAFX improvement (13.9-32.6%) at primary position, five showed large improvement (39.9-162.4%), and one showed no NAFX change (due to his high pretenotomy NAFX). Primary position measured acuities improved in six patients. All patients had reductions in nystagmus amplitudes ranging from 14.6 to 37%. The duration of the foveation period increased in all nine patients (11.2-200%). The percentage improvements in both the NAFX and the LFD decreased with higher pretenotomy values. CONCLUSIONS: In addition to elevating primary position NAFX, tenotomy also broadens the high-NAFX regions. This broadening effect is more prominent in patients who had sharp pretenotomy NAFX peaks. Four-muscle tenotomy produces higher primary position NAFX increases in infantile nystagmus patients whose pretenotomy values are relatively low, with the improvement decreasing at higher pretenotomy values. The tenotomy procedure improves visual function beyond primary position acuity. This extends the utility of surgical therapy to several different classes of patients with INS for whom other procedures are contraindicated. The pretenotomy NAFX can now be used to predict both primary position acuity improvements and broadening of a patient's high-NAFX range of gaze angles. SN - 1091-8531 UR - https://www.unboundmedicine.com/medline/citation/17189150/Effects_of_tenotomy_on_patients_with_infantile_nystagmus_syndrome:_foveation_improvement_over_a_broadened_visual_field_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1091-8531(06)00538-6 DB - PRIME DP - Unbound Medicine ER -