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Richard W Hertle - One of the best experts on this subject based on the ideXlab platform.
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clinical and electrophysiological results of eye Muscle Surgery in 17 patients with downbeat nystagmus
Indian Journal of Ophthalmology, 2019Co-Authors: Richard W Hertle, Ashraf AhmadAbstract:Purpose: To test the hypothesis that eye Muscle Surgery in treatment of patients with acquired downbeat nystagmus results in improvement measures of visual and ocular motor function. Methods: This is a prospective, interventional case series analysis of clinical and electrophyisological data before and after eye Muscle Surgery in 17 patients with acquired downbeat nystagmus who did not respond to medical treatments. Outcome measures included: 1) routine demography and clinical characteristics, 2) subjective oscillopsia (SO), 3) binocular best-corrected visual acuity in the null position (BVA), 3) primary position strabismic deviation (SD), 5) anomalous head posture (AHP), 6) contrast sensitivity function (CS), and 7) nystagmus slow phase velocity (SPV). All patients were followed at least 12 months. Parametric and non-parametric statistical analysis of outcome measure data above pre- and post-treatment were perfomed using standard software on grouped data using computerized software. Results: Patients' age ranged from 5 to 85 years (average 27 years). About 59% were male. Follow up ranged from 1–10 years (average 2.0 years). Around 70% had an associated central nervous systemic diagnosis, 100% had an AHP, oscillopsia and decreased CS, 53% had other eye disease, and 59% had strabismus. There were no complications from Surgery. There were signficant post-treatment improvements in mean/median group BVA, SO, SD, AHP, CS, and SPV. Conclusion: This study supports the hypothesis that eye Muscle Surgery as treatments for patients with acquired downbeat nystagmus can result in improvements in multiple aspects of ocular motor and visual functions.
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clinical and ocular motor complications of extraocular Muscle extirpation for infantile nystagmus syndrome
Journal of Aapos, 2018Co-Authors: Richard W Hertle, L F Dellosso, Jonathan B JacobsAbstract:Purpose To describe the effects of extraocular Muscle extirpation performed after previous eye Muscle Surgery in a 20-year-old woman with infantile nystagmus syndrome (INS) for whom we have 19 years of follow-up data. Methods Clinical examinations were performed. Eye movement data analysis was carried out using the eXpanded Nystagmus Acuity Function (NAFX) and longest foveation domain (LFD). Results The patient re-presented to the authors at age 20, 2 years after bilateral anterior myectomy of the horizontal rectus Muscles, bilateral anterior nasal transposition of the inferior oblique Muscle, and bilateral superior oblique recessions. Evaluation revealed deterioration in nystagmus at lateral gaze angles, new incomitant strabismus with severe loss of convergence, limited ductions, saccadic hypometria, slow saccades, and hypo-accommodation. Also, there was a pre- to post-extirpation minimal change of 21% in her peak NAFX, a 50% decrease in LFD, plus a predominant, asymmetric, multiplanar oscillation. Conclusions It appears that in this patient, horizontal extirpation failed to abolish the nystagmus and caused significant, new, symptomatic deficits interfering with many of the patient's visual functions.
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An interesting case of bilateral bifid insertion of superior rectus Muscle as an intra-operative finding in a patient with oculocutaneous albinism
Surgical and Radiologic Anatomy, 2014Co-Authors: Rashmi Verma, Richard W HertleAbstract:We report a case of bilateral bifid insertion of superior rectus Muscles, in a patient with oculocutaneous albinism as an incidental intraoperative finding during eye Muscle Surgery. The Muscle was successfully operated on and the patient did well postoperatively. To our knowledge, this is the first report of this anomaly.
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Surgery for the treatment of vertical head posturing associated with infantile nystagmus syndrome results in 24 patients
Clinical and Experimental Ophthalmology, 2010Co-Authors: Richard W Hertle, Dongsheng Yang, Kenneth Adams, Roxanne CaterinoAbstract:Background: The study of the clinical and electrophysiological effects of eye Muscle Surgery on patients with infantile nystagmus has broadened our knowledge of the disease and its interventions. Design: Prospective, comparative, interventional case series. Participants: Twenty-four patients with a vertical head posture because of electrophysiologically diagnosed infantile nystagmus syndrome. The ages ranged from 2.5 to 38 years and follow up averaged 14.0 months. Methods: Thirteen patients with a chin-down posture had a bilateral superior rectus recession, inferior oblique myectomy and a horizontal rectus recession or tenotomy. Those 11 with a chin-up posture had a bilateral superior oblique tenectomy, inferior rectus recession and a horizontal rectus recession or tenotomy. Main Outcome Measures: Outcome measures included: demography, eye/systemic conditions and preoperative and postoperative; binocular, best optically corrected, null zone acuity, head posture, null zone foveation time and nystagmus waveform changes. Results: Associated conditions were strabismus in 66%, ametropia in 96%, amblyopia in 46% and optic nerve, foveal dysplasia or albinism in 54%. Null zone acuity increased at least 0.1 logMAR in 20 patients (P < 0.05 group mean change). Patients had significant (P < 0.05) improvements in degrees of head posture, average foveation time in milliseconds and infantile nystagmus syndrome waveform improvements. Conclusions: This study illustrates a successful surgical approach to treatment and provides expectations of ocular motor and visual results after vertical head posture Surgery because of an eccentric gaze null in patients with infantile nystagmus syndrome.
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eye Muscle Surgery for infantile nystagmus syndrome in the first two years of life
Clinical Ophthalmology, 2009Co-Authors: Richard W Hertle, Joost Felius, Dongsheng Yang, Matthew KaufmanAbstract:PURPOSE To report visual and elctrophysioloigcal effects of eye Muscle Surgery in young patients with infantile nystagmus syndrome (INS). METHODS Prospective, interventional case cohort of 19 patients aged under 24 months who were operated on for combinations of strabismus, an anomalous head posture, and nystagmus. All patients were followed at least nine months. Outcome measures, part of an institutionally approved study, included Teller acuity, head position, strabismic deviation, and eye movement recordings, from which waveform types and a nystagmus optimal foveation fraction (NOFF). Computerized parametric and nonparametric statistical analysis of data were perfomed using standard software on both individual and group data. RESULTS Age averaged 17.7 months (13.1-month follow-up). Thirteen (68%) patients had associated optic nerve or retinal disease. 42% had amblyopia, 68% had refractive errors. Group means in binocular Teller acuity (P < 0.05), strabismic deviation (P < 0.05), head posture (P < 0.001), and the NOFF measures (P < 0.01) from eye movement recordings improved in all patients. There was a change in null zone waveforms to more favorable jerk types. There were no reoperations or surgical complications. CONCLUSIONS Surgery on the extraocular Muscles in patients aged less than two years with INS results in improvements in multiple aspects of ocular motor and visual function.
David G Hunter - One of the best experts on this subject based on the ideXlab platform.
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long term surgical outcomes for large angle infantile esotropia
American Journal of Ophthalmology, 2018Co-Authors: Hedva Chiu, Michael J Wan, Ankoor S Shah, David G HunterAbstract:Purpose To report the long-term surgical outcomes for a cohort of children with large-angle infantile esotropia. Design Multicenter, nonrandomized clinical study. Methods Setting: Two tertiary-care pediatric hospitals. Study Population: Children with large-angle (≥55 prism diopters) infantile esotropia. Intervention: Surgical treatment of infantile esotropia. Main Outcome Measure: Success rate at final follow-up (postoperative deviation ≤ 10 prism diopters and no need for retreatment). Results A total of 88 patients with large-angle infantile esotropia were treated during the 13-year study period. Treatment was bilateral medial rectus Muscle recessions in 70 patients, botulinum toxin–augmented Surgery in 15 patients, and 3-Muscle Surgery in 3 patients. After a mean follow-up of 40 months, 20 patients (23%) had a successful outcome compared to 68 treatment failures (77%). Of the 68 treatment failures, 59 had residual or recurrent esotropia and 9 had sequential exotropia. On multivariate logistic regression, treatment modality was the only factor significantly associated with a successful outcome. Specifically, patients treated with botulinum toxin–augmented Surgery were more likely to have a successful outcome compared to patients treated with bilateral medial rectus Muscle recessions. For the 26 patients (30%) who underwent retreatment, the mean number of procedures was 2.1, and 7 (27%) had a deviation of ≤10 prism diopters at final follow-up. Conclusions The overall success rate for treatment of large-angle infantile esotropia was poor in this cohort, with most failures owing to recurrent or residual esotropia. Botulinum toxin–augmented Surgery was associated with a higher success rate at final follow-up.
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changes in lateral comitance after asymmetric horizontal strabismus Surgery
JAMA Ophthalmology, 2015Co-Authors: David G Hunter, Carolyn P GraeberAbstract:Importance Asymmetric horizontal strabismus Surgery is often performed to correct primary gaze alignment without considering the symptoms that may result from misalignment in the patient’s side gaze. Surgical choices influence alignment in side gaze and may contribute to functional and social deficits. Objective To identify the surgical procedures associated with changes of alignment in side gaze to help inform surgical planning for patients with horizontal strabismus. Design, Setting, and Participants The medical records of 1081 horizontal strabismus surgical procedures that were performed at Boston Children’s Hospital during a 2-year period were retrospectively reviewed. Only records with strabismus measurements recorded in the right and left gaze before and after Surgery were included. Data analysis was conducted from September 1, 2012, through June 7, 2015. Main Outcomes and Measures Change in comitance (CIC), determined by measuring the horizontal comitance (the difference between right- and left-gaze strabismus measurements) before and after Surgery. Results The review identified 569 patients who met the inclusion criteria. Of the 491 patients with comitant preoperative alignment, 59 developed postoperative incomitance, of whom 53 (89.9%) had asymmetric Surgery. Of the 78 patients with incomitant preoperative alignment, 36 patients’ (46.2%) deviation had improved to comitance after Surgery; 32 (88.9%) of these patients had asymmetric Surgery. Asymmetric 2-Muscle Surgery had a median CIC of 4.0 while symmetric 2-Muscle Surgery had a median CIC of 1.5 (difference in CIC, 2.5; 95% CI, 2.0-3.0; P Conclusions and Relevance Asymmetric strabismus Surgery can treat incomitant deviations, but it can also create symptomatic incomitant deviations in patients who were previously comitant. Surgical planning should include consideration of the potential for CIC, including the potential for unsatisfactory appearance in side gaze. Patients with binocular vision will be sensitive to diplopia in any gaze direction; in such cases, the consequences of asymmetric Surgery should be considered with particular care.
Dongsheng Yang - One of the best experts on this subject based on the ideXlab platform.
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Surgery for the treatment of vertical head posturing associated with infantile nystagmus syndrome results in 24 patients
Clinical and Experimental Ophthalmology, 2010Co-Authors: Richard W Hertle, Dongsheng Yang, Kenneth Adams, Roxanne CaterinoAbstract:Background: The study of the clinical and electrophysiological effects of eye Muscle Surgery on patients with infantile nystagmus has broadened our knowledge of the disease and its interventions. Design: Prospective, comparative, interventional case series. Participants: Twenty-four patients with a vertical head posture because of electrophysiologically diagnosed infantile nystagmus syndrome. The ages ranged from 2.5 to 38 years and follow up averaged 14.0 months. Methods: Thirteen patients with a chin-down posture had a bilateral superior rectus recession, inferior oblique myectomy and a horizontal rectus recession or tenotomy. Those 11 with a chin-up posture had a bilateral superior oblique tenectomy, inferior rectus recession and a horizontal rectus recession or tenotomy. Main Outcome Measures: Outcome measures included: demography, eye/systemic conditions and preoperative and postoperative; binocular, best optically corrected, null zone acuity, head posture, null zone foveation time and nystagmus waveform changes. Results: Associated conditions were strabismus in 66%, ametropia in 96%, amblyopia in 46% and optic nerve, foveal dysplasia or albinism in 54%. Null zone acuity increased at least 0.1 logMAR in 20 patients (P < 0.05 group mean change). Patients had significant (P < 0.05) improvements in degrees of head posture, average foveation time in milliseconds and infantile nystagmus syndrome waveform improvements. Conclusions: This study illustrates a successful surgical approach to treatment and provides expectations of ocular motor and visual results after vertical head posture Surgery because of an eccentric gaze null in patients with infantile nystagmus syndrome.
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eye Muscle Surgery for infantile nystagmus syndrome in the first two years of life
Clinical Ophthalmology, 2009Co-Authors: Richard W Hertle, Joost Felius, Dongsheng Yang, Matthew KaufmanAbstract:PURPOSE To report visual and elctrophysioloigcal effects of eye Muscle Surgery in young patients with infantile nystagmus syndrome (INS). METHODS Prospective, interventional case cohort of 19 patients aged under 24 months who were operated on for combinations of strabismus, an anomalous head posture, and nystagmus. All patients were followed at least nine months. Outcome measures, part of an institutionally approved study, included Teller acuity, head position, strabismic deviation, and eye movement recordings, from which waveform types and a nystagmus optimal foveation fraction (NOFF). Computerized parametric and nonparametric statistical analysis of data were perfomed using standard software on both individual and group data. RESULTS Age averaged 17.7 months (13.1-month follow-up). Thirteen (68%) patients had associated optic nerve or retinal disease. 42% had amblyopia, 68% had refractive errors. Group means in binocular Teller acuity (P < 0.05), strabismic deviation (P < 0.05), head posture (P < 0.001), and the NOFF measures (P < 0.01) from eye movement recordings improved in all patients. There was a change in null zone waveforms to more favorable jerk types. There were no reoperations or surgical complications. CONCLUSIONS Surgery on the extraocular Muscles in patients aged less than two years with INS results in improvements in multiple aspects of ocular motor and visual function.
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effects of extraocular Muscle Surgery on 15 patients with oculo cutaneous albinism oca and infantile nystagmus syndrome ins
American Journal of Ophthalmology, 2004Co-Authors: Richard W Hertle, Dongsheng Yang, William Anninger, Raed Shatnawi, Vanessa M HillAbstract:Purpose The purpose of this report is to characterize the clinical and electrophysiological effects of extraocular Muscle Surgery in 15 patients with oculo-cutaneous albinism (OCA) and infantile nystagmus syndrome (INS). Our hypothesis is that Surgery on the extraocular Muscles of patients with OCA and INS changes their nystagmus and their visual function. Design Interventional, prospective, cohort, noncomparative case series. Methods All 15 patients had Surgery on all four virgin horizontal recti; three for strabismus alone, three for nystagmus alone, five for an eccentric gaze null zone alone, and four for an eccentric gaze null zone plus strabismus. All patients have been followed for at least six months. All 15 patients had the subjective outcome measure of pre- and postoperative binocular best optically corrected acuity (BBOCA). Objective outcome measures included anomalous head posture (AHP) in nine patients, eye movement recording measures of expanded nystagmus acuity function (NAFX) in 10 patients, null zone position (NUZP) and null zone width (NUZW) in 10 patients, and foveation time (FOV) in nine patients. Results The results are summarized as follows; BBOCA increased 0.1 LogMar or greater in 14 of 15 patients. In those operated on for an AHP with or without associated strabismus the AHP improved significantly ( P P Conclusions This report adds to the evidence that Surgery on the extraocular Muscles in patients with INS has independent neurologic and visual results.
G H Kolling - One of the best experts on this subject based on the ideXlab platform.
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single or combined oblique Muscle Surgery in acquired and congenital superior oblique palsy
Annals of the New York Academy of Sciences, 2005Co-Authors: H Steffen, G H KollingAbstract:Oblique Muscle Surgery with weakening of the inferior oblique Muscle alone or in combination with a tuck of the superior oblique tendon reduces in a dose-dependent relationship the vertical deviation in patients with an acquired or congenital superior oblique palsy. Reduction of cyclotropia and the V-sign is less dose dependent.
Michael J Wan - One of the best experts on this subject based on the ideXlab platform.
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long term surgical outcomes for large angle infantile esotropia
American Journal of Ophthalmology, 2018Co-Authors: Hedva Chiu, Michael J Wan, Ankoor S Shah, David G HunterAbstract:Purpose To report the long-term surgical outcomes for a cohort of children with large-angle infantile esotropia. Design Multicenter, nonrandomized clinical study. Methods Setting: Two tertiary-care pediatric hospitals. Study Population: Children with large-angle (≥55 prism diopters) infantile esotropia. Intervention: Surgical treatment of infantile esotropia. Main Outcome Measure: Success rate at final follow-up (postoperative deviation ≤ 10 prism diopters and no need for retreatment). Results A total of 88 patients with large-angle infantile esotropia were treated during the 13-year study period. Treatment was bilateral medial rectus Muscle recessions in 70 patients, botulinum toxin–augmented Surgery in 15 patients, and 3-Muscle Surgery in 3 patients. After a mean follow-up of 40 months, 20 patients (23%) had a successful outcome compared to 68 treatment failures (77%). Of the 68 treatment failures, 59 had residual or recurrent esotropia and 9 had sequential exotropia. On multivariate logistic regression, treatment modality was the only factor significantly associated with a successful outcome. Specifically, patients treated with botulinum toxin–augmented Surgery were more likely to have a successful outcome compared to patients treated with bilateral medial rectus Muscle recessions. For the 26 patients (30%) who underwent retreatment, the mean number of procedures was 2.1, and 7 (27%) had a deviation of ≤10 prism diopters at final follow-up. Conclusions The overall success rate for treatment of large-angle infantile esotropia was poor in this cohort, with most failures owing to recurrent or residual esotropia. Botulinum toxin–augmented Surgery was associated with a higher success rate at final follow-up.
