June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Incidence of superior oblique palsy after spacer surgery for treatment of Browns syndrome: An honest look at residual superior oblique function.
Author Affiliations & Notes
  • Medha Sharma
    Pediatric ophthalmology, Boston children hospital, Boston, Massachusetts, United States
  • Sarah MacKinnon
    Pediatric ophthalmology, Boston children hospital, Boston, Massachusetts, United States
  • linda dagi
    Pediatric ophthalmology, Boston children hospital, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Medha Sharma, None; Sarah MacKinnon, None; linda dagi, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 2919. doi:
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      Medha Sharma, Sarah MacKinnon, linda dagi; Incidence of superior oblique palsy after spacer surgery for treatment of Browns syndrome: An honest look at residual superior oblique function.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2919.

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

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Abstract

Purpose : Superior oblique suture spacer surgery for treatment of Brown syndrome was introduced to reduce the risk of superior oblique palsy associated with treatment by complete tenotomy. Few studies have provided thorough data on residual superior oblique function. We performed a retrospective clinical observational study of the outcomes of suture spacer surgery detailing impact on postoperative superior oblique function.

Methods : Retrospective chart review of all patients diagnosed with Browns syndrome and treated with suture spacer surgery between 2005-2016 was performed. Patients with simultaneous inferior oblique surgery, orbital mass simulating Brown syndrome or insufficiently detailed sensorimotor evaluation were excluded. Age at surgery, pre-operative sensorimotor examination, size of spacer and latest sensorimotor evaluation available or prior to additional strabismus surgery were abstracted

Results : Of 23 patients treated with suture spacer, 21 met inclusion criteria. Median age at surgery was 59 months (IQR 32 to 78 months). Pre-operative hypotropia in primary position, direct upgaze and affected side gaze was 10 PD (IQR 3 to 11PD), 18PD (IQR 14 to 25 PD) and 18 PD (IQR 10 to 23 PD) respectively. Browns limitation was -4 (IQR -3 to -4) and evidence of preoperative fusion or stereopsis was present in 71%. Spacers ranged from 2 to 9 mm with median of 6mm. At final outcome visit occurring median 16.5 months (IQR 5.5 to 26.5 months) post procedure, median residual Browns limitation was -1 (IQR 0 to -2) and vertical alignment in primary position was orthotropia (IQR 0 to 5 PD hypertropia), direct upgaze was 1 PD hypotropia (IQR 8 PD hypotropia to 2 PD hypertropia) and affected side gaze was 1 PD hypertropia (IQR 4 PD hypotropia to 5 PD hypertropia). Fusion or stereopsis was present in 62%. Twelve patients had good to excellent superior oblique function however 9 developed clinically significant superior oblique palsy, 4 of whom had surgical intervention. Size of spacer did not predict development of palsy.

Conclusions : While adjustable suture spacer treatment of Brown Syndrome may reduce risk of superior oblique underaction, postoperative paresis and palsy remain common problems impacting fusion and functionality in reading position.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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