PMID- 28651813
OWN - NLM
STAT- MEDLINE
DCOM- 20170929
LR  - 20180519
IS  - 1549-4713 (Electronic)
IS  - 0161-6420 (Linking)
VI  - 124
IP  - 10
DP  - 2017 Oct
TI  - Magnetic Oculomotor Prosthetics for Acquired Nystagmus.
PG  - 1556-1564
LID - S0161-6420(17)31076-X [pii]
LID - 10.1016/j.ophtha.2017.05.028 [doi]
AB  - PURPOSE: Acquired nystagmus, a highly symptomatic consequence of damage to the
      substrates of oculomotor control, often is resistant to pharmacotherapy. Although
      heterogeneous in its neural cause, its expression is unified at the effector-the 
      eye muscles themselves-where physical damping of the oscillation offers an
      alternative approach. Because direct surgical fixation would immobilize the
      globe, action at a distance is required to damp the oscillation at the point of
      fixation, allowing unhindered gaze shifts at other times. Implementing this idea 
      magnetically, herein we describe the successful implantation of a novel magnetic 
      oculomotor prosthesis in a patient. DESIGN: Case report of a pilot, experimental 
      intervention. PARTICIPANT: A 49-year-old man with longstanding,
      medication-resistant, upbeat nystagmus resulting from a paraneoplastic syndrome
      caused by stage 2A, grade I, nodular sclerosing Hodgkin's lymphoma. METHODS: We
      designed a 2-part, titanium-encased, rare-earth magnet oculomotor prosthesis,
      powered to damp nystagmus without interfering with the larger forces involved in 
      saccades. Its damping effects were confirmed when applied externally. We
      proceeded to implant the device in the patient, comparing visual functions and
      high-resolution oculography before and after implantation and monitoring the
      patient for more than 4 years after surgery. MAIN OUTCOME MEASURES: We recorded
      Snellen visual acuity before and after intervention, as well as the amplitude,
      drift velocity, frequency, and intensity of the nystagmus in each eye. RESULTS:
      The patient reported a clinically significant improvement of 1 line of Snellen
      acuity (from 6/9 bilaterally to 6/6 on the left and 6/5-2 on the right),
      reflecting an objectively measured reduction in the amplitude, drift velocity,
      frequency, and intensity of the nystagmus. These improvements were maintained
      throughout a follow-up of 4 years and enabled him to return to paid employment.
      CONCLUSIONS: This work opens a new field of implantable therapeutic
      devices-oculomotor prosthetics-designed to modify eye movements dynamically by
      physical means in cases where a purely neural approach is ineffective. Applied to
      acquired nystagmus refractory to all other interventions, it is shown
      successfully to damp pathologic eye oscillations while allowing normal saccadic
      shifts of gaze.
CI  - Copyright (c) 2017 American Academy of Ophthalmology. Published by Elsevier Inc. 
      All rights reserved.
FAU - Nachev, Parashkev
AU  - Nachev P
AD  - Institute of Neurology, University College London, London, United Kingdom.
      Electronic address: p.nachev@ucl.ac.uk.
FAU - Rose, Geoff E
AU  - Rose GE
AD  - Orbital Clinic, Moorfields Eye Hospital NHS Foundation Trust, London, United
      Kingdom; National Institute for Health Research Biomedical Research Centre,
      Institute of Ophthalmology, Bath Street, London, United Kingdom.
FAU - Verity, David H
AU  - Verity DH
AD  - Orbital Clinic, Moorfields Eye Hospital NHS Foundation Trust, London, United
      Kingdom.
FAU - Manohar, Sanjay G
AU  - Manohar SG
AD  - Department of Clinical Neurology, University of Oxford, Oxford, United Kingdom.
FAU - MacKenzie, Kelly
AU  - MacKenzie K
AD  - Strabismus Clinic, Moorfields Eye Hospital NHS Foundation Trust, London, United
      Kingdom.
FAU - Adams, Gill
AU  - Adams G
AD  - Strabismus Clinic, Moorfields Eye Hospital NHS Foundation Trust, London, United
      Kingdom.
FAU - Theodorou, Maria
AU  - Theodorou M
AD  - Strabismus Clinic, Moorfields Eye Hospital NHS Foundation Trust, London, United
      Kingdom.
FAU - Pankhurst, Quentin A
AU  - Pankhurst QA
AD  - Healthcare Biomagnetics Laboratory, University College London, London, United
      Kingdom.
FAU - Kennard, Christopher
AU  - Kennard C
AD  - Department of Clinical Neurology, University of Oxford, Oxford, United Kingdom.
LA  - eng
GR  - Wellcome Trust/United Kingdom
PT  - Case Reports
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20170623
PL  - United States
TA  - Ophthalmology
JT  - Ophthalmology
JID - 7802443
RN  - 0 (Metals, Rare Earth)
SB  - IM
MH  - Eye Movements/physiology
MH  - Humans
MH  - *Magnetic Fields
MH  - Male
MH  - Metals, Rare Earth
MH  - Middle Aged
MH  - Nystagmus, Pathologic/physiopathology/*surgery
MH  - Oculomotor Muscles/physiopathology/*surgery
MH  - *Prostheses and Implants
MH  - Prosthesis Design
MH  - Prosthesis Implantation
MH  - Vision, Ocular/physiology
MH  - Visual Acuity/physiology
PMC - PMC5609850
EDAT- 2017/06/28 06:00
MHDA- 2017/09/30 06:00
CRDT- 2017/06/28 06:00
PHST- 2017/04/06 00:00 [received]
PHST- 2017/05/23 00:00 [revised]
PHST- 2017/05/24 00:00 [accepted]
PHST- 2017/06/28 06:00 [pubmed]
PHST- 2017/09/30 06:00 [medline]
PHST- 2017/06/28 06:00 [entrez]
AID - S0161-6420(17)31076-X [pii]
AID - 10.1016/j.ophtha.2017.05.028 [doi]
PST - ppublish
SO  - Ophthalmology. 2017 Oct;124(10):1556-1564. doi: 10.1016/j.ophtha.2017.05.028.
      Epub 2017 Jun 23.