Two Hypothetical Nystagmus Procedures: Augmented Tenotomy and Reattachment and Augmented Tendon Suture (<i>Sans</i>Tenotomy)

Dell’osso, Louis F.; Tomsak, Robert L.; Thurtell, Matthew J.

doi:10.3928/01913913-20090701-01

Cited by 3 publications

(4 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ideally, these drugs should be evaluated in controlled masked trials. Better understanding of the proprioceptive control of eye movements may make it possible to hone surgical treatments, such as tenotomy and reattachment (149), or even develop medication therapies that act at the insertions of the extraocular muscles (119). Since INS appears to be genetically determined in many individuals (150), specific treatment directed toward the abnormal protein or channel may be effective.…”

Section: Future Developmentsmentioning

confidence: 99%

Therapy for Nystagmus

Thurtell

Leigh

2010

Journal of Neuro-Ophthalmology

View full text Add to dashboard Cite

Pathological forms of nystagmus and their visual consequences can be treated using pharmacological, optical, and surgical approaches. Acquired periodic alternating nystagmus improves following treatment with baclofen, and downbeat nystagmus may improve following treatment with aminopyridines. Gabapentin and memantine are helpful in reducing acquired pendular nystagmus due to multiple sclerosis. Ocular oscillations in oculopalatal tremor may also improve following treatment with memantine or gabapentin. The infantile nystagmus syndrome (INS) may have only a minor impact on vision if "foveation periods" are well developed, but symptomatic patients may benefit from treatment with gabapentin, memantine, or base-out prisms to induce convergence. Several surgical therapies are also reported to improve INS, but selection of the optimal treatment depends on careful evaluation of visual acuity and nystagmus intensity in various gaze positions. Electro-optical devices are a promising and novel approach for treating the visual consequences of acquired forms of nystagmus.

show abstract

Section: Future Developmentsmentioning

confidence: 99%

Therapy for Nystagmus

Thurtell

Leigh

2010

Journal of Neuro-Ophthalmology

View full text Add to dashboard Cite

show abstract

“…Standard procedure The procedure involves severing the extraocular muscle tendons at the point of insertion onto the globe and then reattaching them [39,43]. In patients with predominantly horizontal nystagmus, the procedure is performed on the horizontal rectus muscles of both eyes.…”

Section: Tenotomy and Reattachment Proceduresmentioning

confidence: 99%

Treatment of Nystagmus

Thurtell

Leigh

2011

Curr Treat Options Neurol

Self Cite

View full text Add to dashboard Cite

Patients with congenital and acquired forms of nystagmus are commonly encountered in clinical practice. Many report visual symptoms, such as oscillopsia and blurred vision, which can be alleviated if the nystagmus can be suppressed. Pharmacologic, optical, and surgical treatments are available, with the choice of treatment depending on the characteristics of the nystagmus and the severity of the associated visual symptoms. Downbeat nystagmus can be treated with 4-aminopyridine, 3,4-diaminopyridine, or clonazepam. Upbeat nystagmus can be reduced with memantine, 4-aminopyridine, or baclofen. Torsional nystagmus may respond to gabapentin. Acquired pendular nystagmus in patients with multiple sclerosis is often partially suppressed by gabapentin or memantine. Acquired pendular nystagmus in patients with oculopalatal tremor can respond to gabapentin, memantine, or trihexyphenidyl. Although acquired periodic alternating nystagmus is often completely suppressed by baclofen, memantine can be effective in refractory cases. Seesaw nystagmus can be reduced with alcohol, clonazepam, or memantine. Infantile nystagmus may not cause significant visual symptoms if "foveation periods" are well developed, but the nystagmus can be treated in symptomatic patients with gabapentin, memantine, acetazolamide, topical brinzolamide, contact lenses, or base-out prisms to induce convergence. Several surgical therapies have also been reported to improve infantile nystagmus syndrome (INS), but selection of the appropriate therapy requires preoperative evaluation of visual acuity and nystagmus intensity in different gaze positions. Other treatment options for nystagmus include botulinum toxin injections into the extraocular muscles or retrobulbar space. Electro-optical devices are currently being developed, in order to noninvasively negate the visual consequences of nystagmus.

show abstract

“…The sutures were made following the methodology outlined in 2009 as the "simple ATS method." 2 The line of the extra suturing was placed 3-4 mm posterior and parallel to the usual suture line securing the muscle for the disinsertion-reattachment, recession, or resection. As a technical side note, the suture (double armed 6-0 polyglactin 910) was weaved partial thickness through the muscle with locking bites in both borders of the muscle.…”

Section: Patients' Clinical and Ins Characteristicsmentioning

confidence: 99%

“…It has been speculated that with the former modification the beneficial effects of the T-R procedure might be increased by placement of additional sutures in the distal tendon of each operated extraocular muscle; in the case of the latter modification, simply placing sutures in the distal tendons, without performing the tenotomies, might produce the same therapeutic improvements. 2 This preliminary study tests the first modification of the T-R procedure: values of peak eXpanded Nystagmus Acuity Function (NAFXpk) and longest foveation domain (LFD) before and after AT-R are compared to estimated values of the NAFXpk and LFD with the single-suture T-R procedure. 3 Based on our findings, the authors make suggestions for testing the second ATS procedure.…”

Section: Introductionmentioning

confidence: 99%

Effects of augmented tenotomy and reattachment in the infantile nystagmus syndrome

2016

View full text Add to dashboard Cite

Purpose-To test the hypothesis that augmented tenotomy and reattachment surgery (AT-R), which involves placing an additional suture in each distal tendon during the 4-muscle tenotomy and reattachment (T-R) or other infantile nystagmus syndrome (INS) procedures, could increase the beneficial effects of many types of extraocular muscle (EOM) surgery to treat INS.Methods-Both infrared reflection and high-speed digital video systems were used to record the eye movements in 4 patients with INS before and after AT-R surgery. Data were analyzed using the eXpanded Nystagmus Acuity Function (NAFX) that is part of the OMtools software.Results-Placement of the augmentation suture did not interfere with Kestenbaum, Anderson, bilateral medial rectus muscle recession, or T-R surgeries. The therapeutic effects of AT-R were similar to but not equal to those from the traditional single-suture surgeries (ie, broadening longest foveation domain [LFD] but no improvement of NAFX peak). The average of the NAFX percent improvements after AT-R was within 31% of those estimated from NAFX values before T-R; the average of the percent broadenings of the LFD values after AT-R was within 16%.Conclusions-The AT-R does not improve the foveation quality in INS above the traditional T-R surgery. It is not improved by an additional suture; indeed, some improvements may be diminished by the added suture. The hypothesized augmented-tendon suture technique (sans tenotomy) has been modified and remains to be tested.

show abstract

Two Hypothetical Nystagmus Procedures: Augmented Tenotomy and Reattachment and Augmented Tendon Suture (SansTenotomy)

Cited by 3 publications

References 25 publications

Therapy for Nystagmus

Therapy for Nystagmus

Treatment of Nystagmus

Effects of augmented tenotomy and reattachment in the infantile nystagmus syndrome

Contact Info

Product

Resources

About