[Indication and Results of the Anderson Procedure].

The major goal of extraocular muscle surgery for nystagmus is to reduce the abnormal head turn (AHT) which is caused by an eccentric null zone of the nystagmus. Shifting the null zone to the primary gaze position will eliminate the AHT. The Kestenbaum procedure consists of bilateral recession of the yoke muscles opposite to the AHT, combined with bilateral resection or plication of their antagonists. The Anderson procedure is confined to bilateral recession of the yoke muscles and is therefore less invasive. We report on our experience with the Anderson procedure. Patients and
Methods: From September 2013 to June 2015, we performed the Anderson procedure in 11 consecutive orthotropic patients with infantile idiopathic or sensory defect nystagmus. Patients responsive to convergence inducing prisms who could benefit from artificial divergence surgery were excluded.
Results: Medians and ranges (minimum-maximum) were: Age 7 years (4-30); binocular BCVA 0.5 (0.05-1.0); AHT 30° (20-40); equal recessions on the horizontal yoke muscles opposite to the AHT of 12 mm (10-17), in one case using bovine pericardium grafts. Three (3-6) months post surgery, the AHT was reduced to 7° (0-20). First step success rates, defined by residual AHT ≤ 10° and ≤ 15°, were 73 % (95 % CI 39-93 %) and 82 % (95 % CI 48-97 %). No over-correction or other adverse effects were observed. Two patients later received augmenting surgery. One patient with pre-existing exophoria later required strabismus surgery for exotropia.
Conclusion: The AHT can be significantly reduced or completely corrected by the Anderson procedure. Recessions of at least 10 mm on both yoke muscles were performed. The success rates equaled success rates of augmented Kestenbaum surgery. Compared to the latter, the Anderson procedure is less invasive. It is followed by a shorter healing process. It is a vessel sparing method - an advantage for potential future surgery. Georg Thieme Verlag KG Stuttgart · New York.