Long-term outcome of a silicone expander for Brown's syndrome

Purpose: Assessment of the long-term outcome of a silicone tendon expander for Brown's syndrome. Patients and Methods: Records of 22 eyes of 16 patients with the diagnosis of Brown's syndrome were reviewed. Patients who had previous superior oblique (SO) muscle surgery or previous or concurrent surgery on another muscle were not included. The average follow-up period was 58.4 months. The SO tendon was cut approximately 5 mm away from the nasal border of the superior rectus muscle. The expander, which varied from 5 to 7 mm in length, was placed in the tenotomized SO muscle tendon. Results: Elevation in adduction was obtained in all patients who underwent surgery. One eye had undercorrection, one eye had limitation in downgaze, and three eyes had overcorrection postoperatively. Six eyes had a severe postoperative inflammatory reaction that was successfully treated with topical corticosteroids and oral non-steroidal anti-inflammatory drugs. Six eyes had foreign body sensation that resolved in time. In two eyes, consecutive SO palsy developed. One eye was reoperated for extrusion and the silicone bands were removed from two eyes; these eyes improved in 2 to 4 months. Conclusion: Silicone expander surgery is a challenging procedure used to treat Brown's syndrome. No cyclotorsion occurred after this surgery. This procedure is reversible and repeatable. A learning period is required to obtain the skill needed to avoid entering the sub-Tenon space.