Brown syndrome surgical treatment: A comparison of three superior oblique techniques: Cross-sectional study

To evaluate vertical motility development in patients with Brown syndrome who have undergone different types of superior oblique (SO) muscle surgery.

A retrospective analysis was conducted on the medical records of 174 patients who underwent surgery for Brown syndrome.

The age of the patients, mean visual acuity (VA), the type of surgery, pre- and postoperative abnormal head posture (AHP), and vertical deviation were investigated.

The study comprised patients who were followed up with Brown syndrome and were undergoing surgery for strabismus and AHP.

These individuals exhibited limitations in active elevation during adduction and severe restrictions in elevating the adducted eye, as assessed by forced duction testing (FDT). Three different surgical procedures were performed.

Pre- and postoperative vertical deviation and AHP were measured.

There were 76 male patients and 98 female patients with a mean age of 13.34 ± 5.47 (6-35 years). Fifty-two patients received SO nasal tenotomy, 56 received SO temporal tenotomy, and 66 received SO tendon elongation. Of the 36 patients (20.7%) who had a vertical deviation rate at the 1-year follow-up, 20 underwent the second procedure (SO temporal or nasal tenotomy for hypotropia and inferior oblique anterior transposition for hypertropia), and two underwent the third procedure (inferior oblique anterior transposition for hypertropia). In the first year following surgery, the average vertical deviation in the primary position was 6.85 ± 2.27∆, compared to 15.43 ± 5.27 ∆ before surgery. Following the second and third operations, the average vertical deviation was 2.38 ± 1.59∆ ( P < 0.005).

The success rate was found to be higher in SO tenotomies.