Limits...
Surgical outcomes in correction of Brown syndrome.

Cho YA, Kim S, Graef MH - Korean J Ophthalmol (2006)

Bottom Line: 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.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%).SO palsy due to overcorrection and under-correction with postoperative adhesion should be avoided.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea earth317@yahoo.co.kr

ABSTRACT

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.

Show MeSH

Related in: MedlinePlus

Case 5. (A) Befor surgery. A 20-month-old female presented with limitation of the left eye in adduction (LEA) with esotropia of 40PD. She also experienced an inability to elevate the left eye in adduction and primary gaze. A forced duction test revealed -4 LEA.(B) After surgy. Insertion of a 5.5-mm silicone expander in the SO muscle of the left eye, a 4.5-mm recession of the right medial rectus and a 5-mm recession of the left medial rectus were performed. Orthophoria was obtained in primary gaze with -1 LEA in the left eye.(C) Five years and four months after operation, LEA was completely relieved. The patient obtained orthophoria in all gazes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2908814&req=5

Figure 2: Case 5. (A) Befor surgery. A 20-month-old female presented with limitation of the left eye in adduction (LEA) with esotropia of 40PD. She also experienced an inability to elevate the left eye in adduction and primary gaze. A forced duction test revealed -4 LEA.(B) After surgy. Insertion of a 5.5-mm silicone expander in the SO muscle of the left eye, a 4.5-mm recession of the right medial rectus and a 5-mm recession of the left medial rectus were performed. Orthophoria was obtained in primary gaze with -1 LEA in the left eye.(C) Five years and four months after operation, LEA was completely relieved. The patient obtained orthophoria in all gazes.

Mentions: LEA -4 in the left eye was confirmed under general anesthesia at the time of surgery. Insertion of a 5.5mm silicone expander in the left eye and recession of the MR in both eyes (4.5mm in the right eye and 5mm in the left eye) were performed by YAC. Four months after surgery, -2 LEA remained with orothophoria in the primary gaze. However, the limitation was completely relieved to normal elevation on adduction (Fig. 2).


Surgical outcomes in correction of Brown syndrome.

Cho YA, Kim S, Graef MH - Korean J Ophthalmol (2006)

Case 5. (A) Befor surgery. A 20-month-old female presented with limitation of the left eye in adduction (LEA) with esotropia of 40PD. She also experienced an inability to elevate the left eye in adduction and primary gaze. A forced duction test revealed -4 LEA.(B) After surgy. Insertion of a 5.5-mm silicone expander in the SO muscle of the left eye, a 4.5-mm recession of the right medial rectus and a 5-mm recession of the left medial rectus were performed. Orthophoria was obtained in primary gaze with -1 LEA in the left eye.(C) Five years and four months after operation, LEA was completely relieved. The patient obtained orthophoria in all gazes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908814&req=5

Figure 2: Case 5. (A) Befor surgery. A 20-month-old female presented with limitation of the left eye in adduction (LEA) with esotropia of 40PD. She also experienced an inability to elevate the left eye in adduction and primary gaze. A forced duction test revealed -4 LEA.(B) After surgy. Insertion of a 5.5-mm silicone expander in the SO muscle of the left eye, a 4.5-mm recession of the right medial rectus and a 5-mm recession of the left medial rectus were performed. Orthophoria was obtained in primary gaze with -1 LEA in the left eye.(C) Five years and four months after operation, LEA was completely relieved. The patient obtained orthophoria in all gazes.
Mentions: LEA -4 in the left eye was confirmed under general anesthesia at the time of surgery. Insertion of a 5.5mm silicone expander in the left eye and recession of the MR in both eyes (4.5mm in the right eye and 5mm in the left eye) were performed by YAC. Four months after surgery, -2 LEA remained with orothophoria in the primary gaze. However, the limitation was completely relieved to normal elevation on adduction (Fig. 2).

Bottom Line: 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.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%).SO palsy due to overcorrection and under-correction with postoperative adhesion should be avoided.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea earth317@yahoo.co.kr

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus