To evaluate the long-term outcome and recurrence of abnormal head posture after modified Kestenbaum surgery in patients with nystagmus.

The medical records of 46 patients who underwent modified Kestenbaum procedure in horizontal recti muscles for nystagmus with abnormal head turn were retrospectively reviewed. We assessed the effect of surgery by comparing preoperative and postoperative clinical data such as visual acuity (log MAR) and degree of head turn. A reoperation or abnormal head turn of 10° or more at final visit were defined as recurrence. Patients were divided into 2 groups according to the presence of recurrence or reoperation. Clinical factors associated with recurrence or reoperation were compared between the 2 groups.

The mean visual acuity was 0.38 in the better eye and 0.42 in the worse eye before surgery, which improved to 0.15 and 0.21 after surgery (each p < 0.001), with a mean follow-up period of 124 months. The mean degree of head turn was 41.41° preoperatively and was changed to 2.61° postoperatively ( p < 0.001). The recurrence rate was 23.9% and the reoperation rate was 10.9%. Mental retardation, amblyopia, preoperative visual acuity, degree of head turn, and presence of strabismus were not associated with recurrence or reoperation. The mean age at first surgery was significantly lower in the reoperation group ( p = 0.009). The mean visual acuity in the better eye at postoperative 6 months and in better and worse eyes at postoperative 1 year was significantly worse in the reoperation group ( p = 0.034, 0.012 and 0.009, respectively).

The visual acuity and head turn was improved after modified Kestenbaum surgery in patients with nystagmus and abnormal head posture. The reoperation rates were associated with earlier age of first operation and worse postoperative visual acuity. However, further prospective studies are necessary to clarify these factors.