title: Superior oblique tendon spacer with application of nonabsorbable adjustable suture for treatment of Brown syndrome.
abstract: OBJECTIVE
  To evaluate the outcomes of a superior oblique tendon spacer procedure using nonabsorbable adjustable sutures in patients with Brown syndrome.
  
  
  METHODS
  This noncomparative interventional case series includes 25 eyes of 25 patients with Brown syndrome. In all patients the superior oblique tendon was exposed; two nonabsorbable polyester sutures were placed 4 mm apart, and the tendon was cut. With the use of a slipknot, the cut ends of the tendon were separated 5 to 8 mm. Tendon separation was adjusted intraoperatively according to the exaggerated traction test and indirect ophthalmoscopy.
  
  
  RESULTS
  Overall 25 eyes of 25 patients with mean age of 8.00 +/- 4.62 years were operated and followed for a mean period of 13.2 +/- 7.6 months (range, 3 to 30 months). Mean elevation in adduction improved from -3.96 before surgery to -0.67 (p < 0.001); mean hypotropia improved from 11.08(Delta) to 0.32(Delta) (p < 0.001). Two patients developed overcorrection, but recurrence was not observed in any case. The patients continued to improve over the follow-up period.
  
  
  CONCLUSIONS
  The adjustable superior oblique tendon suture spacer procedure has favorable results and seems to be technically easier than a silicone expander procedure for Brown syndrome.
authors.affiliation: Department of Ophthalmology, School of Medicine, Medical Sciences/Tehran University, Tehran, Iran.
authors.forename: Ziaeddin
authors.initials: Z
authors.lastname: Yazdian
authors.forename: Manijheh
authors.initials: M
authors.lastname: Kamali-Alamdari
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ali Yazdian
authors.forename: Mohammad Taher
authors.initials: MT
authors.lastname: Rajabi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005133:Eye Movements; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D015835:Ocular Motility Disorders / Q000503:physiopathology / Q000601:surgery*; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013710:Tendons / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult