Results in Superior Oblique Sharpening in Brown Syndrome and Systemic Pediatric Diseases
International Journal of Clinical Pediatric Surgery
Volume 2, Issue 1, December 2016, Pages: 1-3
Received: Oct. 30, 2016;
Accepted: Dec. 15, 2016;
Published: Jan. 9, 2017
Views 2515 Downloads 82
Andrea Fernández-Menéndez, Department of Pediatrics, Marqués de Valdecilla University Hospital, Cantabria, Spain
Alfonso Casado, Ophthalmology Department, Sierrallana Hospital, Barrio de Ganzo, Cantabria, Spain
Jose M. Rodríguez, Ophthalmology Department, Ramón y Cajal University Hospital, Madrid, Spain
The objective of this study was to evaluate and compare epidemiological factors, associated diseases, exploration and outcomes in patients with Brown Syndrome (BS) operated of superior oblique (SO) sharpening. This is a cross-sectional comparative study. 24 patients with BS operated of SO sharpening were enrolled in this study. The adduction-elevation restriction (AER), torticollis, visual acuity, treatments, trochlea triamcinolone-injections, age of surgery and systemic diseases were assessed. Fisher’s test was used to analyze if there is any association between the variables analyzed with systemic diseases. Differences between preoperative and postoperative status were analyzed using the Wilcoxon test with Bonferroni correction post hoc. We found a preoperative mean AER (0-3) was 2.88. One year after the surgery, mean AER it was 0.59 (P<0.001). Preoperative torticollis was observed in 79.1% patients. Torticollis was solved in 95.8% of cases in one year follow-up (P<0.001). Most common concomitant diseases were allergic asthma (12.5%), adenoid hypertrophy (12.5%), and heart murmurs (12.5%). No significant association of systemic disease with postsurgical torticollis or AER was found (P>0.05). In conclusion, SO sharpening constitutes a safe and effective surgery for BS, with fewer complications than other techniques previously described.
Jose M. Rodríguez,
Results in Superior Oblique Sharpening in Brown Syndrome and Systemic Pediatric Diseases, International Journal of Clinical Pediatric Surgery.
Vol. 2, No. 1,
2016, pp. 1-3.
Copyright © 2016 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/
) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Jampolsky A. Discussion. J Pediatr Ophthalmol Strabismus. 1995; 32: 35–6.
Wright KW. Brown’s syndrome: diagnosis and management. Trans Am Ophthalmol Soc. 1999; 97: 1023–109.
Dawson E, Barry J, Lee J. Spontaneous resolution in patients with congenital Brown syndrome. J AAPOS. 2009; 13: 116–8.
Wilson ME, Eustis HS, Parks MM. Brown’s syndrome. Surv Ophthalmol. 1989; 34: 153–70.
Bhola R, Rosenbaum AL, Ortube MC, Demer JL. High-Resolution magnetic resonance imaging demonstrates varied anatomic abnormalities in Brown syndrome. J AAPOS. 2005; 9: 438–48.
Llanes AP, Mendez TJ, Naranjo R, Padilla CM. Sindrome de Brown. A proposito de 12 casos. Revista Cubana Oftalmologia. 2004; 17: 1–4.
Merino P, Rivero V, Gómez de Liaño P, Franco G, Yáñez J. Superior oblique sharpening surgery in the treatment of Brown syndrome plus. Arch Soc Esp Oftalmol. 2010 Dec; 85: 395-9.
Costenbader FD, Albert DG. Spontaneous regression of pseudoparalysis of the inferior oblique muscle. JAMA Arch Ophthalmol 1958; 59: 607–8.
Adler FH. Spontaneous recovery in a case of superior oblique tendon sheath syndrome of Brown. Arch Ophthalmol 1959; 61: 1006.
Leone CR Jr, Leone RT. Spontaneous cure of congenital Brown’s syndrome. Am J Ophthalmol 1986; 102: 542–3.
Capasso L, Torre A, Gagliardi V, Magli A. Spontaneous resolution of congenital bilateral Brown’s syndrome. Ophthalmologica 2001; 215: 372–5.
Kaban TJ, Smith K, Orton RB, et al. Natural history of presumed congenital Brown syndrome. Arch Ophthalmol 1993; 111: 943–6.
Kent JS, Makar I. Hypertropia following Spontaneous Resolution of Brown’s Syndrome. Case Rep Ophthalmol. 2012 May; 3: 230-5.
Velez FG, Velez G, Thacker N. Superior oblique posterior tenectomy in patients with Brown syndrome with small deviations in the primary position. J AAPOS. 2006; 10: 214–9.
Sprunger DT, Von Noorden GK, Helveston EM. Surgical results in Brown syndrome. J Pediatr Ophthalmol Strabismus. 1991; 28: 164–7.
Cho YA, Kim S, Graef MH. Surgical outcomes in correction of Brown syndrome. Kor J Ophthalmol. 2006; 20: 33–40.
Wright KW. Superior oblique silicone expander for Brown syndrome and superior oblique overaction. J Pediatr Ophthalmol Strabismus. 1991; 28: 101–7.
Wilson ME, Sinatra RB, Saunders RA. Downgaze restriction after placement of superior oblique tendon spacer for Brown syndrome. J Pediatr Ophthalmol Strabismus. 1995; 32: 29–34.
Kokubo K, Katori N, Kasai K, Hayashi K, Kamisasanuki T. Trochlea surgery for acquired Brown syndrome. J AAPOS. 2014; 18: 56–60.
Horta-Barbosa P. La nueva tecnica quirurgica para el sindrome de Brown. En: Gomez de Liaño F, Ciancia AO, Encuentro estrabologico iberoamericano. Madrid: ONCE. 1992. p. 237–9.
Rodriguez JM, Armada F, Rodriguez J, Gomez de Liaño R. Whettting technique in the surgical treatment of Brown syndrome. Arch Soc Esp Oftalmol. 1997; 72: 489–92.
Suh SY, Le A, Demer JL. Size of the Oblique Extraocular Muscles and Superior Oblique Muscle Contractility in Brown Syndrome. Invest Ophthalmol Vis Sci. 2015; 56: 6114-20.