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  • Surgery for Infantile Nystagmus Confers Modest VA Benefit

    By Lynda Seminara
    Selected by Russell N. Van Gelder, MD, PhD
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    Journal Highlights

    Ophthalmology, March 2023

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    For an Ophthalmic Technol­ogy Assessment, Chang et al. reviewed published literature to assess the effectiveness of surgery for improving VA in patients with infantile nystagmus syndrome (INS). Evidence from the qualifying studies indicates that surgical treatments for INS produce moderate improvement in VA.

    For this review, the PubMed database was searched for all relevant English-language studies published at any time. The final search was con­ducted in January 2022. Of 46 studies that warranted full-text review, 23 were appropriate for inclusion. An evidence rating was assigned to each study. One was a randomized trial (level 2), and the others were case series (level 3). Study participants were children and/or adults with INS, and sample sizes ranged from 10 to 100. The proportion of patients with anomalous head po­sition (AHP), strabismus, and sensory diagnoses varied by study. An outcome measure in all studies was BCVA at dis­tance in the null zone (or central gaze if there was no null zone), and most of the studies included data on monocular and binocular BCVA. All patients had at least one month of follow-up.

    Surgical interventions for INS included large recession, tenotomy and reattachment (TAR), myectomy (with or without pulley fixation), and ante­rior extirpation of horizontal rectus muscles, plus a variety of procedures to correct AHP. The randomized study was a comparison of retro-equatorial recession and TAR of all four horizon­tal recti. Nine case series involved a sin­gle procedure aimed at improving VA. In five others, the objective was AHP correction. In eight studies, at least two procedures were performed to address strabismus or AHP.

    VA outcomes were mixed. Changes in BCVA ranged from no improvement to .3 logMAR. Most studies found logMAR improvement of .05 to .2. Statistically significant VA improve­ment occurred in 12 (75%) of the 16 studies in which statistical analyses were performed. No single procedure appeared to be more beneficial than the others. The rates of complications and reoperation were lowest for patients who underwent TAR and were highest for those who received myectomy or anterior extirpation.

    Despite the statistical significance of BCVA improvement in many stud­ies, the clinical significance of this improvement was marginal for most patients.

    Given the relatively low level of ev­idence of the studies in this review, the authors recommend further research, particularly to determine the best procedures to dampen the nystagmus. Well-designed comparisons of individ­ual or combination procedures “may lead to important insights on the man­agement of INS,” said the authors.

    The original article can be found here.