98th Annual Meeting DOG 2000

K 559

Results of surgery (Kestenbaum procedure and Cüppers procedure) for nystagmus related head turn

M. Gräf, K. Droutsas, S. Stuckenbrok, H. Kaufmann

Introduction: Anomalous head postures taken to dampen a nystagmus can be treated either by Anderson, Goto and Kestenbaum procedures or by creating an exodeviation ("artificial divergence") which is compensated by convergence (Cüppers procedure). We evaluated the effects of Kestenbaum and Cüppers surgery in a retrospective study.

Methods: Solely patients who received surgery for a horizontal head turn (HT) due to nystagmus were considered in this study. Exclusion criteria were: previous eye muscle surgery, strabismus, lacking binocular vision, cerebral disease. The amount of surgery and the pre- and 3-6 months postoperative findings (HT at 5 m and 0.3 m fixation distance, visual acuity at 5 m distance) were evaluated. The patients were divided into group 1: Kestenbaum procedure (£ 3 mm difference of surgery between both eyes), group 2: Cüppers procedure, and group 3: Kestenbaum procedure combined with Cüppers procedure (>3 mm difference).

Results: Of the 68 patients, 44 had a HT to the left side. This preference was statistically significant (p=0.01). Group 1 (n=30): Age at surgery (median, 10%- and 90%-quantile): 7 years (4;32), total amount of surgery: 30 mm (20;40), preop‘HT 30° (20;43), postop‘(n=27) HT 10° (0;30), reduction of HT 67% (25;100), effectivity of surgery 0.8°/mm (0.3;1.2). 2 patients got further surgery. Group 2 (n=25): Age: 13 years (7;45), surgery: 10 mm (6;12), preop‘HT 20° (15;35), postop‘(n=22) HT 6° (-5;20), reduction of HT 59% (25;100), effectivity 1.5°/mm (0.5;3.1). 6 patients got further surgery. Group 3 (n=13): Age: 8 years (7;35), surgery: 30 mm (30;40), preop‘HT 30° (30;40), postop‘HT 10° (-5;15), reduction of HT 67% (50;117), effectivity 0.9°/mm (0.5;1.6). Eight patients (p=0.039) of group 3 had an improvement of visual acuity in HT of 1 line.

Discussion: The Kestenbaum procedure had a dose/effect ratio similar to that of recess/resect surgery for strabismus. In few patients, surgery did not reduce the head turn. Physiological and methodical causes have to be discussed.

Department of Strabismology and Neuroophthalmology, University of Gießen, Friedrichstrasse 18, D – 35385 Gießen