Comparison of superior oblique tendon expander to superior oblique tenotomy for the management of superior oblique overaction and Brown syndrome.

We compared surgical results of superior oblique tenotomy to the superior oblique silicone expander for the treatment of superior oblique overaction and Brown syndrome. Of 24 patients with bilateral superior oblique overaction, 13 underwent tenotomy and 11 had the silicone expander procedure. Reduction of A-pattern to within 10 prism diopters was achieved in 12/13 (92.3%) tenotomy patients and in 10/11 (90.9%) patients undergoing silicone expander (P greater than .05). Correction of superior oblique overaction on versions to within +/- 1 dysfunction was achieved in 22/26 (84.6%) of the tenotomies, and 21/22 (95.5%) silicone expander procedures (P greater than .05). Zero superior oblique dysfunction was found after 14/26 (53.8%) tenotomy procedures versus 18/22 (81.8%) silicone expander operations (P = .041). Superior oblique paresis occurred postoperatively in 4/13 (30.8%) tenotomy patients, whereas none of the 11 patients in the silicone expander group had superior oblique paresis (P = .044). Six patients who underwent superior oblique tenotomy for superior oblique overaction had preoperative stereopsis; following surgery, only two maintained the same level of stereopsis, and three patients totally lost all stereo acuity. All patients in the silicone expander group either maintained or had improved stereo acuity postoperatively. Seven patients with true Brown syndrome were operated on: three underwent the silicone expander procedure and four had a superior oblique tenotomy with an ipsilateral inferior oblique recession. The combination of superior oblique tenotomy with simultaneous ipsilateral inferior oblique recession resulted in an undercorrection in two of the four patients, whereas all three patients in the silicone expander group showed excellent ocular motility postoperatively, with two having normal versions and one a -1 residual limitation.(ABSTRACT TRUNCATED AT 250 WORDS)