Superior oblique silicone expander for Brown syndrome and superior oblique overaction. 1991

K W Wright
Department of Ophthalmology, University of Southern California, School of Medicine, Doheny Eye Institute, Los Angeles.

Standard procedures for weakening the superior oblique muscle have been associated with significant complications in the treatment of superior oblique overaction and Brown syndrome. This article presents a new technique for weakening the superior oblique muscle by lengthening the superior oblique tendon. Lengthening is accomplished by a nasal superior oblique tenotomy, and by inserting a segment of medical grade silicone 240 retinal band between the cut ends of the tendon. This technique was performed on 18 patients (30 eyes), 14 (26 eyes) with superior oblique overaction, and four (one eye each) with Brown syndrome. Preoperatively, patients with superior oblique overaction demonstrated A-patterns between 20 prism diopters and 55 delta, and versions of +2 to +4 superior oblique overaction in at least one eye. Postoperatively, the A-pattern and overaction improved in each case, and 13 of the 14 patients had patterns 10 delta or less. Of the four patients with Brown syndrome, three showed marked improvement of elevation in adduction, without consecutive superior oblique palsy. One had no improvement, even after a second procedure, consisting of superior oblique tenectomy; this case probably represents a non-superior oblique restriction (ie, a pseudo-Brown syndrome). Based on these results, it appears that the silicone expander technique is useful in patients with superior oblique overaction and Brown syndrome secondary to tight superior oblique tendon. This technique allows a predetermined degree of tendon separation and a graded weakening of the superior oblique muscle. Furthermore, by controlling the cut ends of the tendon, the procedure is easily reversible and there is ready access to the tendon should reoperation be necessary for residual overaction.

UI MeSH Term Description Entries
D009801 Oculomotor Muscles The muscles that move the eye. Included in this group are the medial rectus, lateral rectus, superior rectus, inferior rectus, inferior oblique, superior oblique, musculus orbitalis, and levator palpebrae superioris. Extraocular Muscles,Extraocular Rectus Muscles,Inferior Oblique Extraocular Muscle,Inferior Oblique Muscles,Levator Palpebrae Superioris,Musculus Orbitalis,Oblique Extraocular Muscles,Oblique Muscle, Inferior,Oblique Muscle, Superior,Oblique Muscles, Extraocular,Rectus Muscles, Extraocular,Superior Oblique Extraocular Muscle,Superior Oblique Muscle,Extraocular Muscle,Extraocular Muscle, Oblique,Extraocular Muscles, Oblique,Extraocular Oblique Muscle,Extraocular Oblique Muscles,Extraocular Rectus Muscle,Inferior Oblique Muscle,Muscle, Oculomotor,Muscles, Oculomotor,Oblique Extraocular Muscle,Oblique Muscle, Extraocular,Oblique Muscles, Inferior,Oblique Muscles, Superior,Oculomotor Muscle,Rectus Muscle, Extraocular,Superior Oblique Muscles
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D005128 Eye Diseases Diseases affecting the eye. Eye Disorders,Eye Disease,Eye Disorder
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000267 Tissue Adhesions Pathological processes consisting of the union of the opposing surfaces of a wound. Adhesions, Tissue,Surgery-Induced Tissue Adhesions,Surgical Adhesions,Adhesion, Surgery-Induced Tissue,Adhesion, Surgical,Adhesion, Tissue,Adhesions, Surgery-Induced Tissue,Adhesions, Surgical,Surgery Induced Tissue Adhesions,Surgery-Induced Tissue Adhesion,Surgical Adhesion,Tissue Adhesion,Tissue Adhesion, Surgery-Induced,Tissue Adhesions, Surgery-Induced
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D012826 Silicone Elastomers Polymers of silicone that are formed by crosslinking and treatment with amorphous silica to increase strength. They have properties similar to vulcanized natural rubber, in that they stretch under tension, retract rapidly, and fully recover to their original dimensions upon release. They are used in the encapsulation of surgical membranes and implants. Elastomers, Silicone,Rubber Silicone,Silicone Rubber,Elastosil,Microfil,SE-30,Elastosils,Microfils,SE 30,SE30,Silicone Elastomer

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