Further Considerations in the Management of Nystagmus with Myectomy.

To the Editors: Regarding our recent article “Myectomy of the Extraocular Muscles Without Reattachment as a Surgical Treatment for Horizontal Nystagmus,”1 the authors would like to make the following amendments to the section “Technique in Detail” to assist those intending to perform and/or investigate this operation with the full benefit of our latest observations. First, the superior and inferior oblique muscles are no longer considered part of the routine procedure for the reduction of horizontal nystagmus amplitude in younger patients and are included in the procedure only if concurrent Aor V-pattern strabismus or dissociated vertical deviation is simultaneously addressed. Second, we have observed in a subsequent population of 15 patients that preexisting strabismus and prevention of postoperative exotropia can be addressed by graded surgery on the nasal half of the superior rectus muscle. Although a full report is in preparation, anecdotal evidence suggests the following paradigm significantly reduces the risk of reoperation: