Talebnejad Mohammad Reza, Mosallaei Mahnaz, Azarpira Negar, Nowroozzadeh Mohammad Hosein, Zareifar Alireza
Poostchi Ophthalmology Research Center, Shiraz, Iran.
J AAPOS. 2011 Jun;15(3):234-7. doi: 10.1016/j.jaapos.2011.02.009. Epub 2011 Jun 12.
To report the results of treatment of Brown syndrome using Achilles tendon allograft as a superior oblique tendon expander.
Achilles tendon allografts were prepared from the tissue bank. Five eyes of 3 patients with congenital Brown syndrome (mean age, 6 years) were enrolled in the study. Surgery was performed with a superotemporal conjunctival fornix approach. The superior oblique tendon was exposed and severed; then a 2- to 3-mm-wide strip of Achilles tendon (with a thickness of 1-2 mm) was trimmed and sutured between the cut ends using double-armed 5-0 Mersilene sutures. The length of the expander ranged from 7 mm to 8 mm, depending on the severity of the disease.
The preoperative hypotropia in primary position ranged from 15(Δ) to 30(Δ), with abnormal head position in 1 patient. Nine months after the operation, 2 eyes with moderate Brown syndrome showed an improvement in the hypotropia to <3(Δ), and 2 eyes with severe disease had residual hypotropia of 5(Δ). Another eye with severe Brown syndrome had a residual hypotropia of 20(Δ). The elevation in adduction improved by 1 grade in 1 eye and resolved in the other 4 eyes. The amount of correction in the deviation improved with time. None of the patients developed secondary superior oblique palsy, rejection, infection, extrusion, prolonged ocular inflammation, or foreign body sensation.
Superior oblique tendon elongation with Achilles tendon allograft had acceptable short-term results in 4 of 5 eyes treated for Brown syndrome.
报告使用跟腱同种异体移植作为上斜肌腱扩张器治疗布朗综合征的结果。
从组织库中获取跟腱同种异体移植物。3例先天性布朗综合征患者（平均年龄6岁）的5只眼纳入研究。采用颞上结膜穹窿入路进行手术。暴露并切断上斜肌腱；然后修剪一条宽2至3毫米（厚度为1至2毫米）的跟腱条，并用双臂5-0爱惜康缝线缝合于切断端之间。扩张器的长度根据病情严重程度在7毫米至8毫米之间。
术前原在位下斜视度数为15（Δ）至30（Δ），1例患者有异常头位。术后9个月，2例中度布朗综合征患者的下斜视改善至<3（Δ），2例重度患者残留5（Δ）的下斜视。另1例重度布朗综合征患者残留20（Δ）的下斜视。内收时上转在1只眼中改善1级，在其他4只眼中恢复正常。斜视矫正量随时间改善。所有患者均未发生继发性上斜肌麻痹、排斥反应、感染、排斥、持续性眼部炎症或异物感。
对于5只接受治疗的布朗综合征眼中的4只，使用跟腱同种异体移植进行上斜肌腱延长术取得了可接受的短期效果。
