Surgical and functional results of augmented superior oblique muscle z-tenotomy in patients with superior oblique overaction and Brown's syndrome.
To compare the effectiveness of augmented superior oblique Z-tenotomy (SOZT) with fixed standard SOZT in canceling preoperative superior oblique overaction associated with A pattern anisotropia or V pattern in Brown's syndrome.



Sixteen consecutive patients with superior oblique overaction or Brown's syndrome were treated by removal of a triangular piece of the superior oblique tendon near its insertion (augmented SOZT). Outcome was compared with 20 consecutive historical controls after standard SOZT.



The decrease in superior oblique overaction in the right and left eyes and fundus intorsion and the collapse of A pattern anisotropia were more significant for patients with superior oblique overaction (P = .003, P = .007, P = .05, P = .0015, respectively) and patients with Brown's syndrome (P = .025, P = .03, and P = .05, respectively). No study patient with superior oblique overaction and A pattern anisotropia required reoperation compared with 5 of 14 controls (37.5%); rates for patients with Brown's syndrome were 0 for the study group and 3 of 6 (50%) for the control group.



Augmented SOZT is superior to standard SOZT for correcting superior oblique overaction, intorsion, A or V pattern, and stereopsis. It is not associated with complications or reoperation. The size of the Z-tenotomy can be modified according to the intraoperative assessment to achieve symmetric results.
Pediatric Ophthalmology Unit, Schneider Children's Medical Center of Israel, Petah Tiqva.
Moshe
M
Snir
Ronit
R
Friling
Dan
D
Bourla
Dov
D
Weinberger
Ruth
R
Axer-Siegel
D000293:Adolescent; D000328:Adult; D015858:Anisometropia / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003867:Depth Perception / Q000502:physiology; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D015835:Ocular Motility Disorders / Q000503:physiopathology / Q000601:surgery*; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D011183:Postoperative Complications; D012086:Reoperation; D013710:Tendons / Q000503:physiopathology / Q000601:surgery*