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  • Title: Superior oblique tendon expansion with Achilles tendon allograft for treating Brown syndrome.
    Author: Talebnejad MR, Mosallaei M, Azarpira N, Nowroozzadeh MH, Zareifar A.
    Journal: J AAPOS; 2011 Jun; 15(3):234-7. PubMed ID: 21665503.
    Abstract:
    PURPOSE: To report the results of treatment of Brown syndrome using Achilles tendon allograft as a superior oblique tendon expander. METHODS: Achilles 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. RESULTS: The preoperative hypotropia in primary position ranged from 15(Δ) to 30(Δ), 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 <3(Δ), and 2 eyes with severe disease had residual hypotropia of 5(Δ). Another eye with severe Brown syndrome had a residual hypotropia of 20(Δ). 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. CONCLUSIONS: Superior oblique tendon elongation with Achilles tendon allograft had acceptable short-term results in 4 of 5 eyes treated for Brown syndrome.
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