Long-term results of silicone expander for moderate and severe Brown syndrome (Brown syndrome "plus")

Background: The treatment of Brown syndrome has been undergoing an evolutio n toward more effective procedures with fewer operative interventions. Dr K enneth Wright has introduced a procedure of superior oblique muscle tenotom y with a silicone expander to reduce the incidence of overcorrection. Metho ds: There was a retrospective study of 20 eyes of 19 consecutive patients w ith moderate or severe Brown syndrome (Brown syndrome "plus"). Follow-up ra nged from 12 to 72 months. The expander, which varies 6 to 10 mm in length, was placed in all patients in the tenotomized superior oblique muscle tend on 5 mm nasal to the nasal border of the superior rectus muscle using 7-0 o r 8-0 Prolene suture without violating the inner layer of the intermuscular septum. The intermuscular septum was closed over the silicone expander. Re sults: One hundred percent of patients had resolution of the down shoot in adduction and some or full ability to elevate the eye in adduction. Twenty percent of patients required reoperation (12.5% using 5-8 mm expanders) for overcorrection. Restriction of downgaze was not seen postoperatively. Pati ents often show an undercorrection 1 to 6 months postoperatively and improv e or occasionally overcorrect at 1 to 2 years postoperatively. One patient with a 10-mm expander extruded the implant. Discussion: Placement of a 5- t o 8-mm silicone expander in the tenotomized superior oblique muscle tendon is an effective means of correcting Brown syndrome with a low rate of reope ration. Initial undercorrection should not discourage the surgeon because i mprovement may continue for up to 3 years. The goal of treatment should be to convert a moderate or severe Brown syndrome (Brown syndrome plus) to a m ild Brown syndrome ("true" Brown syndrome). Conclusion: This technique redu ces the need for either simultaneous or subsequent inferior oblique muscle weakening and represents an advance in the treatment of Brown syndrome.