Surgical Outcomes in Correction of Brown Syndrome

PURPOSE: To evaluate the outcomes of surgery for Brown syndrome. METHODS: We reviewed the charts of 15 patients who underwent surgery for Brown syndrome. The limitation of elevation in adduction (LEA) ranged from -2 to -4 degrees. A superior oblique muscle (SO) tenotomy was performed in 4 patients, a silicone expander was inserted in the SO of 9 patients, and a SO recession was performed in 2 patients. The results of surgery were analyzed with a follow-up period of more than 6 months, 42.3+/-48.42 months on average. RESULTS: Nine female patients and 6 male patients with unilateral Brown syndrome were selected for this study. The left eye was the affected eye in 9 patients. The degree of preoperative LEA was -2 to -4 in 4 patients in whom SO tenotomy was performed, -3 to -4 in 9 patients treated with the silicone expander, and -2 to -4 in 2 patients treated with SO recession. The LEA was released after surgery in all patients without postoperative adhesion. However, unilateral overaction of the inferior oblique muscle due to excessive weakening of the SO occurred in 1 patient with tenotomy (25%) and in 1 patient with insertion of a silicone expander (11%). CONCLUSIONS: LEA was released after tenotomy, insertion of a silicone expander and recession of the SO in 13 of 15 patients with Brown syndrome. SO palsy due to overcorrection and under-correction with postoperative adhesion should be avoided.

Superior oblique lengthening procedure with silicone expander in rabbits

Using a rabbit model, we assessed the postoperative status and histopathologic findings of superior oblique tenotomy with silicone expander procedure. In the control group we marked and cut the superior oblique, and in the experimental group we inserted a silicone 240 retinal band 4 mm in length along the edges of incision. At the postoperative weeks 1,3,5 and 7, we randomly chose five rabbits and made a histopathologic examination after hematoxylin-eosin and Masson's trichrome stain. The distance between the incised edges was various in the control group, but constant in the experimental group. With time inflammation decreased and fibrosis of the superior oblique increased. Foreign body reaction occurred around the suture material in both groups., but not around the silicone expander. At 5 weeks atrophy of the superior oblique was observed in both groups.From the above results, we concluded that the superior oblique lengthening procedure using silicone expander is a useful surgical method for weakening the superior oblique muscle.

Superior Oblique Tenotomy with Silicone Expander for Superior Oblique Overaetion and Brown Syndrome

Standard procedures for weakening the superior oblique muscle have been associated with significant complications in the treatment of superior oblique overaction and Brown's syndrome. Authors performed a technique for weakening the superior oblique muscle by lengthening the superior oblique tendon with silicone. Lengthening was accomplished by a nasal superior oblique tenotomy and inserting a segment of silicone 240 retinal band between the cut ends of the tendon. This technique was performed on 6 patients (8 eyes), 2 (4 eyes) with superior oblique overaction (SOOA), and 4 (4 eyes) with Brown's syndrome. Preoperatively patients with SOOA demonstrated A-patterns of 26 and 29 prism dioptersrespectively, and versions of +2 or +3 SOOA. Patients with Brown's syndrome demonstrated version of -3 or -4 elevation on adduction. Postoperatively, the A -patterns disappeared and SOOA was improved to 0 or +1, and underaction on adduction improved to 0 or -0.5 in Brown's syndrome. Based on these results, the superior oblique tenotomy with silicone expander is useful in patients with SOOA and Brown's syndrome.

Effect of the Superior Oblique Tendon Silicone Expander for Superior Oblique Overaction

Authors analysed the surgical results of superior oblique silicone expander for the treatment of superior oblique overaction in 8 patients (15 eyes) who were operated at St Mary's Hospital, Catholic University Medical College from October 1990 to December 1991. The results were as follows: 1. Preoperatively, the patients demonstrated versions of +2 overaction in 6 eyes (40%) and +3 to +4 overaction in 9 eyes (60%), And demonstrated A-patterns between 20 delta to 55 delta with a mean of 33 delta. 2. Postoperatively, of the 9 eyes with +3 to +4 overaction, 6 eyes (66.7%) showed no overaction and 3 eyes (33.3%) had +1 residual overaction. Of the 6 eyes with +2 overaction, 4 eyes (66.7%) showed no residual overaction, while 2 eyes (33.3%) had +1 residual overaction. 3. Postoperatively. reduction of A-pattern was from 16 delta to 51 delta with a mean of 27 delta. Bases on these results, it appears that the silicone expander technique is useful for the treatment of superior oblique overaction.