Nystagmus surgery types (1) After years of practical experience, the Nystagmus Research Group of Beijing Children’s Hospital has summarized nine types of nystagmus surgery by referring to the surgery types of famous foreign nystagmus specialists: 1. Surgery without compensatory head position 2. Surgery for nystagmus with tilted head position 3. Surgery for head position with low head position 4. Surgery with horizontal head position 5.Surgical treatment for rotational head position 6.Surgical treatment for nystagmus with combined strabismus 7.Surgical treatment for nystagmus with combined head position and strabismus 8.Surgical treatment for those with pooling block 9.Surgical treatment for those with compound head position After the child comes to the clinic, the initial examination is completed and the diagnosis is clear, our nystagmus research team will conduct a detailed examination of each child’s eye position and head position and other detailed examinations, and determine the type of child according to the above The nine types of nystagmus are assigned to the child, so that a personalized surgical plan can be made for the nystagmus baby. (Video of the surgery) Here are some details about the types. Surgical treatment of nystagmus (2) Congenital idiopathic nystagmus is a condition in which the nystagmus is detected at birth and remains constant throughout life, mostly as impulsive nystagmus. The true etiology is still unknown, and there are several hypotheses and speculations. Most people believe that the lesions are central, but the current state of technology is not yet able to detect these subtle lesions. Most of these nystagmus have a more stable intermediate zone with a distinct compensatory head position, where the face is turned in the opposite direction of the line of sight and the patient can use the compensatory head position to maintain better vision. Surgical treatment is usually an intermediate band shift procedure, including the Anderson;Kestenbaum surgical approach. For small torsional angles in the head position, a regression of one horizontal muscle in each eye can be performed, i.e., 7 to 8 mm for the external rectus muscle and 5 to 6 mm for the internal rectus muscle; for large torsional angles in the head position, a 7 mm regression of the external rectus muscle combined with a 5 mm shortening of the internal rectus muscle or a 5 mm regression of the internal rectus muscle combined with a 7 mm shortening of the external rectus muscle; for torsional angles in between the above, the surgical volume is reduced by 1 mm for each of the internal and external rectus muscles on the basis of the surgical volume; for very large torsional angles, the If the torsion angle is between the above two, the surgical volume is reduced by 1 mm for each of the internal and external rectus muscles; if the torsion angle is very large, the surgical volume is increased by 1 mm for each of the four muscles. Types of surgery for nystagmus (III) Four extraocular muscles with supernormal amount of posterior migration for congenital nystagmus Four horizontal rectus muscles with massive regression: Bietti and Bagolini first introduced this method in 1960, and then von Noorden and Sprunger discussed this method in detail. The procedure was first introduced by Bietti and bagolini in 1960 and later discussed in detail by von Noorden and Sprunger. Arruga A suggested the use of a posterior fixation suture in addition to the four horizontal rectus retractors. Arruga A suggests the addition of posterior fixation sutures to the four horizontal rectus retreatments, which may allow for consolidation of the rectus strength reduction. However, this procedure has some limitations, as it is prone to secondary strabismus after surgery, limited eye movements, and regression of the postoperative results have been reported with the classic surgical approach for the treatment of nystagmus. The type of surgery for nystagmus (d) Windmill surgery procedure for congenital nystagmus head rotation A child with compound head position nystagmus with head rotation and head tilted to one shoulder tilt type of vision. This type of head position not only has a face turn, vertical head position of the jaw, but also a head position with the head tilted toward the shoulder. For this particular type of nystagmus surgery, we designed a windmill type of surgery by referring to the surgical approach of many foreign experts and borrowing from the surgical protocol of rotational strabismus, i.e., a vertical rectus and/or oblique muscle shift approach. Significant improvement in head position can be expected after surgery. Types of surgery for nystagmus (v) Nystagmus combined with strabismus surgery If a child has both nystagmus and strabismus, how should nystagmus combined with strabismus surgery be chosen? Nystagmus surgery can be combined with strabismus correction surgery. The general rule is to perform nystagmus surgery on the dominant eye and strabismus correction surgery on the non-dominant eye. Before surgery we must specify the eye of gaze, the position of the intermediate band, the number of head torsion angles and the direction of face turn, the nature and degree of strabismus, and use this as the basis for designing the surgery. The intermediate band shift to correct the head torsion angle is designed to be performed on the dominant eye as much as possible, while the volume of surgery on the strabismic eye is the algebraic sum of the volume of surgery to correct the head position and correct the strabismus. If the head position torsion angle correction results in an excessive surgical volume for strabismus, the surgical volume in the dominant eye is considered and then adjusted, and the surgical volume in the dominant eye can be appropriately reduced to avoid losing sight of the other.