关键词: 先天性眼球震颤/外科学, 异常头位, 眼肌手术

Abstract:  Objective  To evaluate the surgery efficacy for congenital nystagmus with vertical head posture. Design Retrospective case series. Participants Seventeen congenital nystagmus patients with vertical head posture, who were diagnosed between July. 2010 and Mar. 2012 in Beijing Children's Hospital were enrolled. The ages ranged from 4 to 12 years, average 7.8±2.3 years. Methods Seven cases with a chin-up posture were accepted the operation of bilateral superior oblique tenectomy + bilateral inferior rectus recession. Ten patients with a chin-down posture were accepted the operation of bilateral superior rectus recession + inferior oblique tenectomy or myectomy. In which, four cases with horizontal strabismus were accepted bilateral lateral rectus, and two cases with convergence damping were accepted medial rectus recession as well. Degrees of head posture, null zone best corrected visual acuity(BCVA), the frequency, amplitude and intensity of nystagmus waveform were observed and recorded before and after the surgery. All the participants were followed up 6 to 23 months, averaged 11.2±2.9 months. Main Outcome Measures Degrees of head posture, null zone BCVA, and the frequency, amplitude and intensity of nystagmus waveform before and after the surgery. Results The degree of head posture was less than 15°in 4 cases, between 15°and 30°in 7 cases, and more than 30 °in 6 cases preoperatively; and less than 15°in 13 cases, between 15°and 30°in 3 cases, more than 30 °1 cases at the end of follow up（χ2=9.936, P=0.007）. Null zone BCVA increased from 0.22±0.12 preoperatively to 0.26±0.13 postoperatively (t=-2.66, P=0.017) , and the frequency（3.19 Hz preoperatively to 2.27 Hz postoperatively, t=6.77, P=0.000）, amplitude （22.9 degrees preoperatively to 16.6 degrees postoperatively, t=4.132, P=0.001）and intensity（75.1 Hz*degree preoperatively to 37.1 Hz*degree postoperatively, t=6.275, P=0.000）of nystagmus waveforms were significantly improved. Conclusion Surgery treatment for congenital nystagmus with vertical head posture can provide the expectations of ocular motor and visual results. The surgery should be designed according to different situation of different patients. (Ophthalmol CHN, 2014, 23: 115-120)

Key words:  congenital nystagmus/surgery, anomalous head posture, eye muscle surgery