Awad Abdulaziz H, Digout Leonard G, Al-Turkmani Shahira, Khan Arif O, Fallata Amna
Department of Medical Education, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
J AAPOS. 2003 Aug;7(4):274-8. doi: 10.1016/s1091-8531(03)00113-7.
To report the effectiveness of large-segment superior oblique tendon expanders for severe congenital Brown syndrome.
Medical records of 12 consecutive patients with severe congenital Brown syndrome were evaluated retrospectively. All patients had a hypotropia > 20 prism diopters in primary position. A superior oblique tendon lengthening procedure, using a 10- to 12-mm-long silicone band, was performed on each patient. Preoperative and postoperative extraocular motility patterns were analyzed, and the final results were graded as "excellent," "good," "fair," "poor, undercorrected" and "poor, overcorrected."
As of the last recorded follow-up examination (mean, 32 months), three patients had an excellent result, six had a good result, three had a fair result, and none had a poor result. All patients experienced an improvement in their severe Brown syndrome, with 100% showing a postoperative primary-position hypotropia < 8 prism diopters. Postoperative limitation of elevation in adduction was either -1 or -2 for all patients. No patient required further surgery, and no extrusions of the implants were noted.
The superior oblique tendon expander procedure appears to be an effective tool in the surgical treatment of severe Brown syndrome. The use of a large-segment (10- to 12-mm) band seems to be an appropriate choice when dealing with patients having primary-position hypotropia > 20 prism diopters.
报告大段上斜肌腱扩张器治疗重度先天性布朗综合征的有效性。
回顾性评估12例连续性重度先天性布朗综合征患者的病历。所有患者在第一眼位均有>20棱镜度的下斜视。对每位患者进行上斜肌腱延长手术，使用10至12毫米长的硅胶带。分析术前和术后的眼外肌运动模式，最终结果分为“优”“良”“中”“差，欠矫”和“差，过矫”。
截至最后一次记录的随访检查（平均32个月），3例结果为优，6例为良，3例为中，无结果为差的病例。所有患者的重度布朗综合征均有改善，100%患者术后第一眼位下斜视<8棱镜度。所有患者内收位上抬受限均为-1或-2。无患者需要进一步手术，未观察到植入物脱出。
上斜肌腱扩张器手术似乎是治疗重度布朗综合征的有效手段。对于第一眼位下斜视>20棱镜度的患者，使用大段（10至12毫米）硅胶带似乎是合适的选择。
