Surgical Treatments to Improve Visual Acuity in Infantile Nystagmus Syndrome: A Report by the American Academy of Ophthalmology

Melinda Y Chang; Gil Binenbaum; Gena Heidary; Kara M Cavuoto; David G Morrison; Rupal H Trivedi; Stephen J Kim; Stacy L Pineles

doi:10.1016/j.ophtha.2022.10.006

Surgical Treatments to Improve Visual Acuity in Infantile Nystagmus Syndrome: A Report by the American Academy of Ophthalmology

Ophthalmology. 2023 Mar;130(3):331-344. doi: 10.1016/j.ophtha.2022.10.006. Epub 2022 Nov 24.

Authors

Melinda Y Chang¹, Gil Binenbaum², Gena Heidary³, Kara M Cavuoto⁴, David G Morrison⁵, Rupal H Trivedi⁶, Stephen J Kim⁷, Stacy L Pineles⁸

Affiliations

¹ Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California. Electronic address: aambrus@aao.org.
² Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
³ Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
⁴ Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida.
⁵ Hess Pediatric Ophthalmology, Saint Petersburg, Florida.
⁶ Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina.
⁷ Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee.
⁸ Jules Stein Eye Institute, Los Angeles, California.

Abstract

Purpose: To review the literature on the efficacy of surgical procedures to improve visual acuity (VA) in patients with infantile nystagmus syndrome (INS).

Methods: Literature searches were last conducted in January 2022 in the PubMed database for English-language studies with no date restrictions. The combined searches yielded 354 abstracts, of which 46 were reviewed in full text. Twenty-three of these were considered appropriate for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist.

Results: One included study was a randomized trial; the remaining 22 were case series. The 23 studies included children and adults with INS and a variable proportion with anomalous head position (AHP), strabismus, and sensory diagnoses. The surgical interventions evaluated included large recessions, tenotomy and reattachment (TAR), myectomy with or without pulley fixation, and anterior extirpation of the 4 horizontal rectus muscles, as well as various procedures to correct an AHP in which VA was reported as a secondary outcome. The data were mixed, with improvements in binocular best-corrected visual acuity (BCVA) ranging from no improvement to 0.3 logarithm of the minimum angle of resolution (logMAR), or 3 lines. (Most studies were in the range of 0.05-0.2 logMAR.) Statistically significant improvement in VA was noted in 12 of 16 studies (75%) that performed statistical analyses, with no clear advantage of any single procedure. Complications and reoperations were lowest in patients who underwent TAR and highest in those who underwent myectomy or anterior extirpation.

Conclusions: The best available evidence suggests that eye muscle surgery in patients with INS results in a modest improvement in VA.

Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.

Keywords: Anderson procedure; Cuppers artificial divergence procedure; Kestenbaum procedure; Myectomy; Recessions; Rectus muscles.

Publication types

Review
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Child
Eye Movements
Humans
Nystagmus, Pathologic*
Oculomotor Muscles / surgery
Ophthalmologic Surgical Procedures / methods
Ophthalmology*
Posture
Visual Acuity

Grants and funding

K23 EY033790/EY/NEI NIH HHS/United States