Comparison of superior oblique suture spacers and superior oblique silicone band expanders

To compare suture spacers with silicone band expanders in superior oblique-weakening surgery.

We retrospectively reviewed the charts of consecutive patients who had superior oblique weakening with either suture spacers or silicone expanders and had been followed for a minimum follow-up of 6 months. The ductions, versions, and the degree of fundus torsion were analyzed in all patients before and after surgery. In addition, surgery time and postoperative complications were analyzed.

The record review identified 25 patients, of whom 13 had been treated with superior oblique muscle suture spacers and 12 with superior oblique muscle silicone expanders. Both groups showed improved ductions and versions. In patients with Brown syndrome, complete normalization of superior oblique muscle overaction occurred in 67% of patients who had suture spacers and 67% of patients who had silicone expanders. In patients with A-pattern strabismus, normal function of the superior oblique muscle occurred in 75% of patients with suture spacers and 67% of patients with silicone expanders. Surgery time was significantly less in patients who had suture spacers. Severe orbital inflammation occurred in 1 patient around the silicone band and was managed by removal of the implant.

Both suture spacers and silicone expanders improved the comitance of versions and normalized superior oblique muscle function. Longer surgery time and more severe inflammatory reaction are possible drawbacks of silicone expanders.