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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.

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Related in: MedlinePlus

Case 15. (A) Before surgery. The six-year-old boy had -4 limitation of elevation in adduction (LEA) and -4 limitation of elevation in the primary gaze of the right eye. He had 8° esophoria and 13° hypotropia of the right eye. He preferred left head turning of 10°.(B) After surgery. LEA -4 was confirmed by a forced duction test at the time of surgery. Recession of 8 mm of the SO, combined with a 5-mm Mersilene loop-suture was performed to lengthen the tendon of the SO by 13-mm. One day after surgery, the LEA had disappeared and normal ocular movement was obtained in all gazes.
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Figure 3: Case 15. (A) Before surgery. The six-year-old boy had -4 limitation of elevation in adduction (LEA) and -4 limitation of elevation in the primary gaze of the right eye. He had 8° esophoria and 13° hypotropia of the right eye. He preferred left head turning of 10°.(B) After surgery. LEA -4 was confirmed by a forced duction test at the time of surgery. Recession of 8 mm of the SO, combined with a 5-mm Mersilene loop-suture was performed to lengthen the tendon of the SO by 13-mm. One day after surgery, the LEA had disappeared and normal ocular movement was obtained in all gazes.

Mentions: Case 15. A six-year-old boy had -4 LEA and -4 limitation of elevation in the primary gaze of the right eye. He also demonstrated eight degrees of esophoria with 13° of HOT in primary gaze, and he preferred 10 degrees of left head-turning. FDT revealed severe (-4) LEA of the left eye at the time of surgery. Eight mm of recession of the SO combined with a 5-mm Mersilene loop-suture was performed by MG to lengthen SO by 13mm. By one day after surgery, the LEA had disappeared and normal ocular movement was obtained in all gazes (Fig. 3). At 8 months postoperatively, he showed an orthophoria in primary gaze both at distance and near with 0-5° of head turn, and 15° of elevation in adduction.


Surgical outcomes in correction of Brown syndrome.

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

Case 15. (A) Before surgery. The six-year-old boy had -4 limitation of elevation in adduction (LEA) and -4 limitation of elevation in the primary gaze of the right eye. He had 8° esophoria and 13° hypotropia of the right eye. He preferred left head turning of 10°.(B) After surgery. LEA -4 was confirmed by a forced duction test at the time of surgery. Recession of 8 mm of the SO, combined with a 5-mm Mersilene loop-suture was performed to lengthen the tendon of the SO by 13-mm. One day after surgery, the LEA had disappeared and normal ocular movement was obtained in all gazes.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Case 15. (A) Before surgery. The six-year-old boy had -4 limitation of elevation in adduction (LEA) and -4 limitation of elevation in the primary gaze of the right eye. He had 8° esophoria and 13° hypotropia of the right eye. He preferred left head turning of 10°.(B) After surgery. LEA -4 was confirmed by a forced duction test at the time of surgery. Recession of 8 mm of the SO, combined with a 5-mm Mersilene loop-suture was performed to lengthen the tendon of the SO by 13-mm. One day after surgery, the LEA had disappeared and normal ocular movement was obtained in all gazes.
Mentions: Case 15. A six-year-old boy had -4 LEA and -4 limitation of elevation in the primary gaze of the right eye. He also demonstrated eight degrees of esophoria with 13° of HOT in primary gaze, and he preferred 10 degrees of left head-turning. FDT revealed severe (-4) LEA of the left eye at the time of surgery. Eight mm of recession of the SO combined with a 5-mm Mersilene loop-suture was performed by MG to lengthen SO by 13mm. By one day after surgery, the LEA had disappeared and normal ocular movement was obtained in all gazes (Fig. 3). At 8 months postoperatively, he showed an orthophoria in primary gaze both at distance and near with 0-5° of head turn, and 15° of elevation in adduction.

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