Whole tendon disinsertion of superior oblique for the treatment of Brown syndrome: a comparative study with multiple techniques.

Abstract

PURPOSE\nTo evaluate the results of a temporal whole superior oblique (SO) tendon disinsertion technique compared with other SO tendon-weakening procedures.\n\n\nMETHODS\nThe medical records of patients who underwent an SO procedure at University of Health Sciences Beyoğlu Eye Research and Training Hospital from January 2008 to January 2018 for treatment of Brown syndrome were reviewed retrospectively. Patients with follow-up of at least 12 months were included. The following data were included in our analysis: pre- and postoperative ocular ductions, versions, and vertical deviations; presence of abnormal head position (AHP); complications; and success rates of procedures.\n\n\nRESULTS\nThe record review identified 158 patients, of whom 52 patients had nasal tenotomy, 6 had nasal tenectomy, 48 had SO tendon elongation by suture spacer and 6 by silicone spacer, and 46 patients had temporal tendon disinsertion of the SO. The rate of AHP decreased from 91.3% to 4.3% postoperatively, and the preoperative mean limitation of elevation in adduction and hypotropia decreased from -3.60Δ ± 0.65Δ and -2.26Δ ± 4.28Δ to -0.47 ± 0.79 and -0.34 ± 2.67Δ postoperatively, respectively, in the temporal tendon disinsertion group. SO palsy was not observed after temporal disinsertion surgery, but undercorrection, overcorrection, and adhesion were seen in 8.7%, 8.7%, and 4.3% of patients, respectively, and a second surgery was needed for 17.4% of patients because of vertical deviations. The success rate of temporal tendon disinsertion technique was not significantly different from those of the other SO procedures (P = 0.91).\n\n\nCONCLUSIONS\nTemporal disinsertion of the SO tendon may be as effective as other SO-weakening procedures.