Surgical Outcomes in Correction of Brown Syndrome

Abstract

PurposeTo evaluate the outcomes of surgery for Brown syndrome.MethodsWe 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.ResultsNine 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%).ConclusionsLEA 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.

Brown Syndrome: Features And Long Term Results Of Management

“…In Dubinsky-Pertzov's study, 9 patients were men (52.9%) and 8 were women (47.1%), and Sekeroglu et al (5) reported 18 (40.9%) men and 26 (59.1%) women patients (4). Various rates have been found of the involvement of the eye; of 60% left eye (6) versus 40% right eye, 19 (43.2%) right eye versus 25 (56.8%) left eye (5), and nine left eye affected of 15 patients (7). In our study, 98 (47%) right eyes were affected versus 92 (43%) left eyes.…”

“…In our study, tenotomy was the most frequently performed surgical procedure (52.6% tenotomy, 40.5% nasal tenotomy, and 12.1% temporal tenotomy). Inferior oblique muscle overaction (IOOA) frequently occurred after a tenotomy or tenectomy procedure of SO (11). Post-operative SO palsy and IOOA occurred in 20% of our study group.…”

Horizontal Deviations in Congenital Brown Syndrome

“…Yazdian et al 9 reported that 4 of 25 (16%) patients with Brown syndrome underwent horizontal rectus muscle surgery for correction of horizontal strabismus in addition to superior oblique weakening; however, no further details were provided regarding the type and extent of the deviations or the procedures performed. Cho et al 10 reported an even higher percentage of horizontal deviations in Brown syndrome, recording that 12 of 15 patients (80%) in their study had horizontal misalignment; 47% (7 of 15) exodeviations of 10 to 30 PD and 33% (5 of 15) esodeviations of 8 to 20 PD. 10 Fifty-four percent (8 of 15) of patients underwent horizontal rectus muscle surgery in addition to superior oblique tendon weakening.…”

“…Cho et al 10 reported an even higher percentage of horizontal deviations in Brown syndrome, recording that 12 of 15 patients (80%) in their study had horizontal misalignment; 47% (7 of 15) exodeviations of 10 to 30 PD and 33% (5 of 15) esodeviations of 8 to 20 PD. 10 Fifty-four percent (8 of 15) of patients underwent horizontal rectus muscle surgery in addition to superior oblique tendon weakening. Similarly, in our study, 8 of 16 (50%) patients with congenital Brown syndrome had significant primary position misalignment, most commonly exotropia (up to 30 PD), requiring surgical correction.…”

Superior oblique tendon spacer with application of nonabsorbable adjustable suture for treatment of Brown syndrome

“…1 Indications for surgery include presence of abnormal head posture and hypotropia in primary position. 2 Many procedures have been suggested for treatment of Brown syndrome (Table 1). Superior oblique tenotomy is one of the most popular procedures, its major advantage being that the operation is technically simple and fast compared with other superior oblique weakening procedures; the drawback of this technique is the possibility of iatrogenic superior oblique palsy with overcorrection, which may be irreversible.…”