Wright K W
Department of Ophthalmology, University of Southern California, School of Medicine, Doheny Eye Institute, Los Angeles.
J Pediatr Ophthalmol Strabismus. 1991 Mar-Apr;28(2):101-7. doi: 10.3928/0191-3913-19910301-11.
Standard procedures for weakening the superior oblique muscle have been associated with significant complications in the treatment of superior oblique overaction and Brown syndrome. This article presents a new technique for weakening the superior oblique muscle by lengthening the superior oblique tendon. Lengthening is accomplished by a nasal superior oblique tenotomy, and by inserting a segment of medical grade silicone 240 retinal band between the cut ends of the tendon. This technique was performed on 18 patients (30 eyes), 14 (26 eyes) with superior oblique overaction, and four (one eye each) with Brown syndrome. Preoperatively, patients with superior oblique overaction demonstrated A-patterns between 20 prism diopters and 55 delta, and versions of +2 to +4 superior oblique overaction in at least one eye. Postoperatively, the A-pattern and overaction improved in each case, and 13 of the 14 patients had patterns 10 delta or less. Of the four patients with Brown syndrome, three showed marked improvement of elevation in adduction, without consecutive superior oblique palsy. One had no improvement, even after a second procedure, consisting of superior oblique tenectomy; this case probably represents a non-superior oblique restriction (ie, a pseudo-Brown syndrome). Based on these results, it appears that the silicone expander technique is useful in patients with superior oblique overaction and Brown syndrome secondary to tight superior oblique tendon. This technique allows a predetermined degree of tendon separation and a graded weakening of the superior oblique muscle. Furthermore, by controlling the cut ends of the tendon, the procedure is easily reversible and there is ready access to the tendon should reoperation be necessary for residual overaction.
在治疗上斜肌亢进和布朗综合征时，传统的减弱上斜肌的手术方法常伴有严重并发症。本文介绍一种通过延长上斜肌腱来减弱上斜肌的新技术。延长通过鼻侧上斜肌断腱术完成，并在肌腱断端间插入一段医用级硅胶240视网膜带。该技术应用于18例患者（30只眼），其中14例（26只眼）为上斜肌亢进，4例（每例1只眼）为布朗综合征。术前，上斜肌亢进患者的A征在20棱镜度至55棱镜度之间，至少一只眼的上斜肌亢进度数为+2至+4。术后，每例患者的A征和上斜肌亢进均有改善，14例患者中有13例的A征度数在10棱镜度或以下。4例布朗综合征患者中，3例内收位上转明显改善，未出现连续性上斜肌麻痹。1例即使在第二次手术（上斜肌切除术）后仍无改善；该病例可能代表非上斜肌受限（即假性布朗综合征）。基于这些结果，硅胶扩张技术似乎对上斜肌亢进及继发于上斜肌腱紧张的布朗综合征患者有用。该技术可实现预定程度的肌腱分离及上斜肌的分级减弱。此外，通过控制肌腱断端，该手术易于逆转，如有必要因残留亢进需再次手术时，可方便地触及肌腱。
