Design and Efficacy of Surgery for Horizontal Idiopathic Nystagmus with Abnormal Head Posture and Strabismus

The design and efficacy of surgery for horizontal idiopathic nystagmus （HIN） with abnormal head posture and strabismus were investigated. Different surgical procedures were selected according to the angle of head turn in 44 cases of HIN with abnormal head posture and strabismus. For patients with a head turn of 15° or less, the Anderson procedure was used; the yoke muscles were recessed upon slow-phase. For patients with a head turn between 15° and 25°, the surgery was designed as a Kestenbaum 5-4-4-5 procedure. For patients with a head turn of 25° or more, the surgery was designed as a Parks 5-8-6-7 procedure. The surgery to correct the abnormal head posture was performed on the fixating eye while that to correct the deviation was then performed on the non-fixating eye at the same time. The amount of surgery of the horizontal rectus muscles on the nonfixating eye was sum of the angle of head turn and the degree of deviation, which was calculated as follows： recession/resection amount of medial and lateral rectis/2×5=angle of head turn±degree of deviation. The results showed as follows： （1） Visual acuity： the visual acuity in the primary ocular position increased two lines or more in 35 patients, accounting for 79.55%. Nine patients had no or only one-line improvement, accounting for 20.45% of the entire study population; （2） The degree of deviation in the primary ocular position： 37 cases had a normal primary ocular position or the degree of deviation ≤8△ after surgery, accounting for 84.09%. Six patients had a residual degree of deviation of 8△―15△, accounting for 13.64%. One patient had a residual degree of deviation 〉20△, accounting for 2.27% of the patients examined; （3） Abnormal head posture： 34 patients had a normal head posture or a head turn of less than 5°, accounting for 72.27%. Eight patients had a residual head turn of 5°―15°, accounting for 18.18%. Two patients had a head turn of 15°― 25°, accounting for 4.55%. It was concluded that different surgical procedures based on the angle of head turn and the relationship between deviation and null zone can eliminate anomalous head posture, correct deviation, and improve vision acuity in the primary ocular position simultaneously.

Binocular vision and abnormal head posture in children when watching television

AIM： To determine the association between the binocular vision and an abnormal head posture（AHP）when watching television（TV） in children 7-14 y of age.·METHODS： Fifty normal children in the normal group and 52 children with an AHP when watching TV in the AHP group were tested for spherical equivalents, far and near fusional convergence（FC） and fusional divergence（FD） amplitudes, near point of convergence, far and near heterophoria, accommodative convergence/accommodation ratio and stereoacuity. The values of these tests were compared between the two groups. The independent t test was applied at a confidence level of95%.·RESULTS： The far and near FC amplitudes and far FD amplitudes were lower in the AHP group（the far FC amplitudes： break point 13.6±5.4~△, recovery point 8.7±5.4~△.The near FC amplitudes： break point 14.5 ±7.3~△, recovery point 10. 3 ± 5. 1~△. The far FD amplitudes ： break point3.9±2.7~△, recovery point 2.6±2.3~△） compared with those in the normal group（the far FC amplitudes： break point19.1 ±6.2△, recovery point 12.4 ±4.5~△. The near FC amplitudes： break point 22.3 ±8.0~△, recovery point 16.1 ±5.7~△. The far FD amplitudes： break point 7.0 ±2.1~△,recovery point 4.6 ±1.9~△）. Other tests presented no statistically significant differences.·CONCLUSION： An association between the reduced FC and FD amplitudes and the AHP in children when watching TV is proposed in the study. This kind of AHP is considered to be an anomalous manifestation which appears in a part of puerile patients of fusional vergence dysfunction.