Superior oblique split tendon lengthening for management of brown syndrome

Brown syndrome is a rare ocular motility disorder characterized by limited elevation of the eye in adduction position, due to mechanical limitation of the superior oblique tendon. For patients with severe ocular motility restrictions, the treatment of Brown syndrome with superior oblique split tendon lengthening (SO-STL) presents a promising way to relieve the superior oblique tendon restriction, thereby enhancing eye movement and alignment.

This study evaluated Patients with severe Brown's syndrome using the superior oblique split tendon elongation technique.

Retrospective research comprising all patients with Brown's syndrome in whom superior oblique split tendon elongation was done by a single surgeon at Menoufia University Hospital. Data was obtained from patients' files. The study was conducted, statistics were analyzed, and the research was produced over the period from June 2024 to December 2024.

When compared to preoperative data, abnormal head posture improved considerably after surgery (31.3% vs. 87.5%, p = 0.037). Limitation of elevation in adduction significantly improved postoperatively (-0.75 ± 1.12) than preoperatively (-3.47 ± 0.50), with a 95% CI of -3.05-(-2.4), p < 0.001). The hypotropia in the primary position was substantially decreased postoperatively (4.52 ± 5.77) than preoperatively (17.06 ± 6.89), with a 95% CI of -3.07-(-2.67), p < 0.001.

SO-STL was found to be an effective procedure for managing Brown syndrome, with significant improvement in preoperative signs e.g.: abnormal head posture, hypotropia and limited elevation in adduction, with relatively minimal operative complications.