Superior oblique tendon spacer with application of nonabsorbable adjustable suture for treatment of Brown syndrome

PurposeTo evaluate the outcomes of a superior oblique tendon spacer procedure using nonabsorbable adjustable sutures in patients with Brown syndrome.MethodsThis noncomparative interventional case series includes 25 eyes of 25 patients with Brown syndrome. In all patients the superior oblique tendon was exposed; two nonabsorbable polyester sutures were placed 4 mm apart, and the tendon was cut. With the use of a slipknot, the cut ends of the tendon were separated 5 to 8 mm. Tendon separation was adjusted intraoperatively according to the exaggerated traction test and indirect ophthalmoscopy.ResultsOverall 25 eyes of 25 patients with mean age of 8.00 ± 4.62 years were operated and followed for a mean period of 13.2 ± 7.6 months (range, 3 to 30 months). Mean elevation in adduction improved from −3.96 before surgery to −0.67 (p < 0.001); mean hypotropia improved from 11.08Δ to 0.32Δ (p < 0.001). Two patients developed overcorrection, but recurrence was not observed in any case. The patients continued to improve over the follow-up period.ConclusionsThe adjustable superior oblique tendon suture spacer procedure has favorable results and seems to be technically easier than a silicone expander procedure for Brown syndrome.