Kestenbaum procedure with combined muscle resection and tucking for nystagmus-related head turn

Literature has dealt extensively with dose-effect relations for recess-resect procedures for correction of horizontal nystagmus-related head turn. However, muscle tucking procedures have some advantages compared to resection procedures. Aim of this study was to evaluate dose-effect relations of Kestenbaum surgery with symmetrical combined recession and tucking (instead of resection) of the horizontal rectus muscles for the reduction of a nystagmus-related head turn. In a retrospective study, clinical findings of 42 patients who consecutively underwent treatment in our institution between 2000 and 2011 were investigated. The patients were aged 4-57 years (median age 6 years). For all patients, surgery aimed to correct a horizontal head turn (to the right: 18 patients) due to infantile nystagmus. The head turn was measured with a goniometer with the patient fixing the smallest age-appropriate target distinguishable for the patient. The median absolute head turn before surgery was 30A degrees (min. 15A degrees, max. 45A degrees). The four horizontal rectus muscles were recessed or tucked between 5.5 and 10 mm, median 9 mm. All four muscles were recessed or tucked for the same amount. At the first postoperative day, the median dose-effect relation was 1.88A degrees reduction of head turn per millimeter surgery on one eye (min. 0.5A degrees/mm, max. 3.2A degrees/mm). The median head turn was 0A degrees (min. -20A degrees, max. 15A degrees). Surgery was considered successful in 88 % of the patients with a reduction of the head turn to max. 10A degrees. Data of 36 patients were available for the long-term postoperative period (median 1.5 years; min. 6 weeks, max. 11 years). The median head turn was 10A degrees (min. -16A degrees, max. 30A degrees). The median dose-effect relation was reduced to 1.35A degrees/mm per eye (min. 0A degrees/mm, max. 2.9A degrees/mm). Surgery was considered successful in 72 % of the patients with a reduction of the head turn to max. 10A degrees. Three patients showed an overcorrection with a head turn of 8A degrees, 15A degrees and 16A degrees to the other side. A squint has not been induced. The dose-effect relation for Kestenbaum surgery with symmetrical combined recession and tucking of the horizontal rectus muscles is comparable to the dose-effect relation reported by other authors for symmetrical combined recession and resection