Superior oblique tendon expansion with Achilles tendon allograft for treating Brown syndrome

PurposeTo report the results of treatment of Brown syndrome using Achilles tendon allograft as a superior oblique tendon expander.MethodsAchilles tendon allografts were prepared from the tissue bank. Five eyes of 3 patients with congenital Brown syndrome (mean age, 6 years) were enrolled in the study. Surgery was performed with a superotemporal conjunctival fornix approach. The superior oblique tendon was exposed and severed; then a 2- to 3-mm-wide strip of Achilles tendon (with a thickness of 1–2 mm) was trimmed and sutured between the cut ends using double-armed 5-0 Mersilene sutures. The length of the expander ranged from 7 mm to 8 mm, depending on the severity of the disease.ResultsThe preoperative hypotropia in primary position ranged from 15Δ to 30Δ, with abnormal head position in 1 patient. Nine months after the operation, 2 eyes with moderate Brown syndrome showed an improvement in the hypotropia to <3Δ, and 2 eyes with severe disease had residual hypotropia of 5Δ. Another eye with severe Brown syndrome had a residual hypotropia of 20Δ. The elevation in adduction improved by 1 grade in 1 eye and resolved in the other 4 eyes. The amount of correction in the deviation improved with time. None of the patients developed secondary superior oblique palsy, rejection, infection, extrusion, prolonged ocular inflammation, or foreign body sensation.ConclusionsSuperior oblique tendon elongation with Achilles tendon allograft had acceptable short-term results in 4 of 5 eyes treated for Brown syndrome.