June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Effect of Superior Oblique Posterior 7/8ths Tenectomy on Anomalous Head Positioning in Patients with Brown Syndrome
Author Affiliations & Notes
  • Meredith Hart Remmer
    Ophthalmology, NYU School of Medicine, New York, NY
  • Milan P. Ranka
    Ophthalmology, NYU School of Medicine, New York, NY
    Pediatric Ophthalmic Consultants, New York, NY
  • Mark A. Steele
    Ophthalmology, NYU School of Medicine, New York, NY
    Pediatric Ophthalmic Consultants, New York, NY
  • Footnotes
    Commercial Relationships Meredith Remmer, None; Milan Ranka, None; Mark Steele, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 5218. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to Subscribers Only
      Sign In or Create an Account ×
    • Get Citation

      Meredith Hart Remmer, Milan P. Ranka, Mark A. Steele; Effect of Superior Oblique Posterior 7/8ths Tenectomy on Anomalous Head Positioning in Patients with Brown Syndrome. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5218.

      Download citation file:


      © ARVO (1962-2015); The Authors (2016-present)

      ×
  • Supplements
Abstract
 
Purpose
 

Brown Syndrome, or superior oblique (SO) tendon sheath syndrome, is characterized by overaction of the SO tendon, seen clinically as a restriction of elevation above midline in adduction. Surgical management is necessary in patients who demonstrate a significant vertical deviation in primary gaze or an anomalous head positioning (AHP) in order to maintain binocular fusion. Classical treatment includes complete SO tenectomy, recession, and spacer tenotomy. These procedures are limited by inconsistent results including scarring, under-elevation in adduction and persistent diplopia. The use of SO posterior 7/8ths tenectomy has shown to be effective in minimizing complications such as loss of torsional function and SO palsy. The purpose of this study is to evaluate the effect of SO posterior 7/8ths tenectomy on AHP in patients with Brown Syndrome.

 
Methods
 

Retrospective chart review was conducted from 2003 to 2014 for patients with Brown Syndrome and an anomalous head positioning who underwent ipsilateral SO posterior 7/8ths tenectomy. Brown Syndrome was confirmed intra-operatively through forced duction testing.

 
Results
 

A total of 8 patients (3 male) met inclusion criteria. The mean age at surgery was 43 +/- 21 months (median 37, range 17 to 79 months). Of the 8 patients, 6 had simultaneous horizontal muscle surgery. All had SO overaction with the inability to elevate past midline in adduction.<br /> Mean pre-operative vertical deviation in primary gaze was 6.4 prism diopters (PD) +/- 4.4, range 2 to 16 PD.<br /> At the most recent postoperative visit, 6 patients (75%) had complete resolution of their AHP (5 following initial surgery and 1 following reoperation). Two patients had mild persistent AHP, but were improved from preoperative evaluation. No patient had restored elevation past midline in adduction.<br /> Mean post-operative vertical deviation in primary gaze was 1.0 PD +/- 2.8. (p <0.01)<br /> Average post-operative follow-up was 32 months. No surgical complications were noted.

 
Conclusions
 

Our study demonstrates that SO posterior 7/8ths tenectomy is an effective procedure for improving both AHP and vertical deviation in primary gaze in Brown syndrome. All patients improved from their initial AHP. This approach should be considered to potentiate binocular fusion in these patients.  

 
SO Posterior Tenectomy A. Isolated SO tendon B. Posterior tenectomy C. Remaining anterior 1/8 tendon
 
SO Posterior Tenectomy A. Isolated SO tendon B. Posterior tenectomy C. Remaining anterior 1/8 tendon

 
×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×