A Preliminary Study on the Outcome of Plication Augmentation of the Augmented Anderson Procedure for Patients with Infantile Nystagmus Syndrome and a Face Turn

Purpose: To report the results of plication augmentation of the augmented Anderson procedure in patients with infantile nystagmus syndrome and face turn. Methods: In this retrospective study, all patients who underwent plication augmentation of the augmented Anderson procedure between August 2015 and November 2018 were included. Our study included patients older than 6 years with a face turn >25°. We also included patients with residual face turns ≥15° after Anderson‑type procedures. The face turn was measured by a goniometer and also quantified with prisms placed with apex in the direction of the face turn. We plicated the medial rectus of one eye by 5.0 mm and lateral rectus of the fellow eye by 7.0 mm based on the direction of the face turn in addition to the augmented Anderson procedure. Patients were reviewed on the 1st postoperative day, 1st month, and every 6 months thereafter. Results: Eight patients with a mean face turn of 27.5° ± 6.5° underwent plication augmentation of the augmented Anderson procedure. Two patients had residual face turns after a previous Anderson‑type procedure. We obtained a mean correction of 25° ± 6.5° with a median prismatic correction of 45 prism diopters (PD) for each eye. The median face turn at the last review was 2.5°, and all patients were corrected to within 10°. Excluding patients operated for residual face turns, we had a mean dose response of 2.7 PD/mm and 1.7°/mm of surgery on each eye. Five patients had an improvement in null zone visual acuity. Two patients had a restriction in ocular motility of −2 in the direction of the recessed extraocular muscle at the last review, and the remaining had a −1 restriction. Conclusions: Plication augmentation of the augmentation Anderson procedure appears to be a safe and effective procedure for patients with infantile nystagmus syndrome and a face turn more than 25°. It may also be used for residual face turns more than 15°.