Long-term Results of an Intraoperative Adjustable Superior Oblique Tendon Suture Spacer Using Nonabsorbable Suture for Brown Syndrome

Objective: To investigate the long-term surgical outcome of Brown syndrome using an intraoperative adjustable superior oblique (SO) tendon suture spacer. Design: Retrospective case series. Participants: Thirteen patients with congenital unilateral Brown syndrome operated on at the Wolfe Eye Clinic from 2001 through 2007. Methods: Retrospective analysis of consecutive patients managed with the SO suture spacer followed up for at least 10 months. Main Outcome Measures: Surgical intervention for patients having severe or moderate forms of Brown syndrome. Postoperative effect on abnormal head posture, vertical strabismus in primary gaze, vertical strabismus into affected side gaze, and elevation in adduction. Results: The mean duration of follow-up was 30 months (range, 10-72 months). Abnormal head posture improved from 13° (range, 0°-30°) to 0.4° (range, 0°-5°). Vertical strabismus in primary gaze improved from -10Δ (range, 0Δ to -35Δ) to 2.8Δ (range, -16Δ to 16Δ). Vertical in side gaze improved from -20Δ (range, -35Δ to -8Δ) to -1.5Δ (range, -20Δ to 18Δ). Elevation in adduction improved from -3.5 (range, -4 to -2) to -0.4 (range, -2 to 4). Four patients had an overcorrection and 2 patients experienced an increasing late effect. In no patient did a late under correction develop. Conclusions: The SO suture spacer procedure alleviated abnormal head positions in patients with Brown syndrome by improving vertical strabismus in primary position and in the affected field of gaze while avoiding overcorrection in contralateral gaze. The benefits of the procedure persisted over time. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.