Tags

Type your tag names separated by a space and hit enter

Two hypothetical nystagmus procedures: augmented tenotomy and reattachment and augmented tendon suture (Sans tenotomy).
J Pediatr Ophthalmol Strabismus. 2009 Nov-Dec; 46(6):337-44.JP

Abstract

PURPOSE

To review the hypothetical mechanism and therapeutic benefits of the four-muscle tenotomy and reattachment (T&R) procedure using knowledge accrued over the 10 years since its proposal; to describe an augmented tendon suture (ATS) technique to improve the procedure based on one of the originally suggested alternative methods (mechanical); and to hypothesize a new ATS procedure to achieve the same therapeutic benefits without extraocular muscle tenotomy or reattachment to the globe.

METHODS

Standard surgical methods were used.

RESULTS

The T&R procedure damps and improves infantile nystagmus syndrome (INS) waveforms, improves eXtended Nystagmus Acuity Function (NAFX) values, broadens the NAFX peak versus gaze angle, and damps slow eye movements but not saccades. The T&R procedure also damps acquired pendular and downbeat nystagmus, decreasing the patients' oscillopsia, and lowers the target acquisition time in INS.

CONCLUSION

The T&R procedure directly affects only the enthesis of the tendon; there is idiosyncratic variation in the distribution of afferent fibers in the tendons. The ATS technique consists of placing several additional sutures in the tendon proximal to the tenotomy. Based on the hypothetical proprioceptive mechanism for the beneficial effects of the T&R procedure, the authors hypothesize that the ATS technique will maximize the therapeutic benefits and that an ATS procedure, using only tendon sutures without tenotomy, will duplicate the therapeutic effects of T&R. Eliminating the tenotomy component results in a simpler procedure more suitable for single-session, multi-muscle surgery that may be required for improving the waveforms of multiplanar nystagmus and less prone to cause complications.

Authors+Show Affiliations

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

Pub Type(s)

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

Language

eng

PubMed ID

19928738

Citation

Dell'Osso, Louis F., et al. "Two Hypothetical Nystagmus Procedures: Augmented Tenotomy and Reattachment and Augmented Tendon Suture (Sans Tenotomy)." Journal of Pediatric Ophthalmology and Strabismus, vol. 46, no. 6, 2009, pp. 337-44.
Dell'Osso LF, Tomsak RL, Thurtell MJ. Two hypothetical nystagmus procedures: augmented tenotomy and reattachment and augmented tendon suture (Sans tenotomy). J Pediatr Ophthalmol Strabismus. 2009;46(6):337-44.
Dell'Osso, L. F., Tomsak, R. L., & Thurtell, M. J. (2009). Two hypothetical nystagmus procedures: augmented tenotomy and reattachment and augmented tendon suture (Sans tenotomy). Journal of Pediatric Ophthalmology and Strabismus, 46(6), 337-44. https://doi.org/10.3928/01913913-20091104-05
Dell'Osso LF, Tomsak RL, Thurtell MJ. Two Hypothetical Nystagmus Procedures: Augmented Tenotomy and Reattachment and Augmented Tendon Suture (Sans Tenotomy). J Pediatr Ophthalmol Strabismus. 2009 Nov-Dec;46(6):337-44. PubMed PMID: 19928738.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Two hypothetical nystagmus procedures: augmented tenotomy and reattachment and augmented tendon suture (Sans tenotomy). AU - Dell'Osso,Louis F, AU - Tomsak,Robert L, AU - Thurtell,Matthew J, Y1 - 2009/11/18/ PY - 2008/11/12/received PY - 2008/12/10/accepted PY - 2009/11/26/entrez PY - 2009/11/26/pubmed PY - 2010/1/22/medline SP - 337 EP - 44 JF - Journal of pediatric ophthalmology and strabismus JO - J Pediatr Ophthalmol Strabismus VL - 46 IS - 6 N2 - PURPOSE: To review the hypothetical mechanism and therapeutic benefits of the four-muscle tenotomy and reattachment (T&R) procedure using knowledge accrued over the 10 years since its proposal; to describe an augmented tendon suture (ATS) technique to improve the procedure based on one of the originally suggested alternative methods (mechanical); and to hypothesize a new ATS procedure to achieve the same therapeutic benefits without extraocular muscle tenotomy or reattachment to the globe. METHODS: Standard surgical methods were used. RESULTS: The T&R procedure damps and improves infantile nystagmus syndrome (INS) waveforms, improves eXtended Nystagmus Acuity Function (NAFX) values, broadens the NAFX peak versus gaze angle, and damps slow eye movements but not saccades. The T&R procedure also damps acquired pendular and downbeat nystagmus, decreasing the patients' oscillopsia, and lowers the target acquisition time in INS. CONCLUSION: The T&R procedure directly affects only the enthesis of the tendon; there is idiosyncratic variation in the distribution of afferent fibers in the tendons. The ATS technique consists of placing several additional sutures in the tendon proximal to the tenotomy. Based on the hypothetical proprioceptive mechanism for the beneficial effects of the T&R procedure, the authors hypothesize that the ATS technique will maximize the therapeutic benefits and that an ATS procedure, using only tendon sutures without tenotomy, will duplicate the therapeutic effects of T&R. Eliminating the tenotomy component results in a simpler procedure more suitable for single-session, multi-muscle surgery that may be required for improving the waveforms of multiplanar nystagmus and less prone to cause complications. SN - 0191-3913 UR - https://www.unboundmedicine.com/medline/citation/19928738/Two_hypothetical_nystagmus_procedures:_augmented_tenotomy_and_reattachment_and_augmented_tendon_suture__Sans_tenotomy__ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=19928738.ui DB - PRIME DP - Unbound Medicine ER -