Tendon surgery in Brown's syndrome.
OBJECTIVE
Longitudinal tenectomy of the reflected tendon of the superior oblique muscle resulted in full recovery in a series of cases of Brown's syndrome after surgery by one of the authors.


METHODS
A survey of the records of cases of Brown's syndrome was done to assess the criteria for patients requiring surgery and to evaluate the methods used. Included in the study were 9 eyes of patients who underwent surgery over the course of 1 year. Criteria identified in cases in this study include: preoperative compulsory head tilt in primary position of gaze, severe restriction of Hess chart in the affected eye, and an enlarged field in the healthy eye; intraoperative thickening of the tendon preventing free slippage through the trochlea in the forced duction test. The surgical method consisted of trimming a swelling that was consistently found on the reflected tendon of the superior oblique muscle in all patients undergoing surgery. Enough of the swelling was removed to allow free slippage of the tendon through the trochlea, as judged by the forced duction test. Sulphamide powder soaked in delayed action steroid compound (methylprednisolone acetate) was applied to prevent postoperative adhesions.


RESULTS
A normal head posture and a satisfactory upward vergence were achieved in all patients from the first days after surgery, and were maintained throughout the follow up, as shown in the pre- and postoperative photographs and Hess charts.


CONCLUSIONS
A preliminary exploration of the reflected tendon of the superior oblique muscle is warranted in cases of Brown's syndrome; when a thickening of the tendon is found, its surgical trimming is advised. Our findings suggest that delayed development of the trochlea may be a possible cause of Brown's syndrome.
Maggi
R
R
Bambino Gesu Children's Hospital, Rome, Italy.
Maggi
C
C
D002648:Child; D002675:Child, Preschool; D005133:Eye Movements; D005260:Female; D006801:Humans; D008297:Male; D015835:Ocular Motility Disorders / Q000601:surgery*; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D013710:Tendons / Q000601:surgery*; D016896:Treatment Outcome