Trochlea surgery for acquired Brown syndrome

To describe surgical treatment of acquired Brown syndrome by trochlea reconstruction and trochlea adhesiotomy.

The medical records of patients with acquired Brown syndrome who underwent intraoperative forced duction testing under direct view of the trochlea from 2010 to 2012 were retrospectively reviewed. In all cases, the site of restricted movement was identified, after which either the trochlea was reconstructed or the trochlear adhesion was removed. Surgical results were assessed by means of the pre- and postoperative Hess chart scores and binocular single vision test scores.

Six eyes of 6 patients were included. In 4 patients the trochlea was reconstructed; in 2, the adhesion was removed. A significant improvement in the Hess chart scores was observed postoperatively in 5 of the 6 patients (P = 0.047). Binocular single vision test scores also significantly improved in 4 of 5 patients (P = 0.019). No iatrogenic superior oblique muscle paresis was observed in any of the patients.

Our technique of isolating the source of limitation of elevation and treating with trochlea reconstruction or adhesion removal successfully treated acquired Brown syndrome in these patients.