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

ABSTRACT

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.