Surgery for Acquired Nystagmus in Patients With Cerebellar Dysfunction

Background: To report the association of downbeat nystagmus and chin-down head posture with cerebellar dysfunction and the results of treatment with bilateral superior rectus recession and bilateral inferior oblique anteriorization. Methods: This is a retrospective series of patients with cerebellar ataxia treated for downbeat nystagmus, oscillopsia, and abnormal head posture with bilateral superior rectus recession and bilateral inferior oblique anteriorization between 2000 and 2022. Results: Four patients underwent the procedure. All 4 patients had systemic signs and symptoms of cerebellar ataxia, confirmed by a neurologist as well as MRI findings involving the cerebellum. All patients had oscillopsia, downbeat nystagmus with damping in up gaze, and chin-down head posture. All patients underwent bilateral superior rectus recession and bilateral inferior oblique anteriorization. Median follow-up period was 3 years. Oscillopsia in primary position and abnormal head posture resolved in all patients. Conclusions: Downbeat nystagmus with oscillopsia associated with cerebellar disorders respond well to surgical treatment with bilateral superior rectus recession and bilateral inferior oblique anteriorization.