Brown syndrome: clinical features and results of superior oblique tenotomy

ABSTRACT Purpose: This study was conducted to further define the specific clinical characteristics of patients with Brown syndrome and evaluate the outcomes of superior oblique tenotomy in its surgical management. Methods: A retrospective analysis of the medical charts of 45 patients with Brown syndrome was performed, which revealed that 11 patients underwent superior oblique tenotomy due to abnormal head posture and/or hypotropia and 1 patient underwent bilateral superior oblique tendon elongation with a silicone band due to abnormal head posture. In the last patient, silicone bands were removed at the postoperative 3rd month due to the lack of improvement in the abnormal head posture and the limitation of elevation in adduction. Simultaneous horizontal rectus muscle surgery was performed in four patients. Results: There was a predominance of female gender, right eye, congenital form, unilaterality, A-pattern, and an abnormal head posture type with a combination of chin up and head tilting. Bilateral form was observed only in female patients. Amblyopia was detected in two patients. Among patients aged >5 years, 40% had reduced stereopsis. Abnormal head posture was found in 60% of patients. More than half of them were diagnosed with a vertical and/or horizontal deviation. Tenotomy procedure eliminated the abnormal head posture in all patients and significantly improved the mean limitation of elevation in adduction and hypotropia (p=0.001, p=0.012). Two patients developed inferior oblique overaction in the operated eye. There was complete spontaneous resolution in two patients. Conclusions: The clinical features of patients with Brown syndrome in our study are considerably consistent with those of previous reports. The present study demonstrated the effectiveness of superior oblique tenotomy with less overcorrection in the surgical treatment of Brown syndrome.

摘要

目的：本研究旨在进一步明确Brown综合征（Brown syndrome）患者的具体临床特征，并评估上斜肌腱切断术（superior oblique tenotomy）在其手术治疗中的疗效。

方法：对45例Brown综合征患者的病历资料开展回顾性分析，其中11例因异常头位和/或下斜视接受上斜肌腱切断术，1例因异常头位采用硅胶带行双侧上斜肌腱延长术。该例患者于术后3个月因异常头位无改善、内收位上转受限而取出硅胶带。另有4例患者同期行水平直肌手术。

结果：本队列中女性、右眼受累、先天性发病类型、单侧患病、A型斜视以及仰头伴头倾斜的异常头位类型占比更高。双侧受累仅见于女性患者。2例患者合并弱视。年龄大于5岁的患者中，40%存在立体视锐度下降。60%的患者存在异常头位。超过半数患者存在垂直和/或水平斜视。上斜肌腱切断术可完全消除所有患者的异常头位，并显著改善内收位上转受限程度与下斜视（p=0.001，p=0.012）。2例手术眼出现下斜肌功能过强。2例患者症状自发完全缓解。

结论：本研究中Brown综合征患者的临床特征与既往相关报道基本一致。本研究证实，上斜肌腱切断术用于Brown综合征的手术治疗效果确切，且过度矫正发生率较低。