Postoperative Adjustable Surgery of the Superior Oblique Tendon

The Zanvyl Krieger Children's Eye Center at The Wilmer Institute The Johns Hopkins University School of Medicine, Baltimore, MD 21287-9028, USA.
Strabismus 04/2005; 13(1):5-10. DOI: 10.1080/09273970590889941
Source: PubMed


To describe a surgical procedure for loosening or tightening the superior oblique (SO) tendon that enables bedside adjustment following the surgery, with surgical outcome reported.
A permanent suture separates the two cut ends of the SO tendon, with a sliding noose for adjustment. The noose is accessed by having the patient look up or straight ahead, not down, during adjustment at the bedside. Records of 17 patients who underwent this surgery between June 2000 and January 2003 were reviewed and analyzed for outcome.
Seventeen patients, 18 eyes, mean age 43.7 years (range 5.9 to 71 years) had SO surgery with postoperatively adjustable sutures. Twelve eyes of 11 patients had a loosening procedure, and six eyes had a tightening procedure. Seven of the patients had had precious eye muscle surgery, four having had previous surgery on the same SO tendon. All but one patient returned for the follow-up examination, ranging from 1.5 to 7 months postoperatively. Torsional imbalances in 12 patients improved in all but two. In four patients with a preoperative A pattern, the A pattern improved from 16 PD to 0 PD on average. In eight patients with vertical misalignment in straight ahead gaze who had no other cyclovertical muscle surgery simultaneously, the mean reduction was 7 PD. All patients except one had improvement in preoperative symptoms.
Both loosening and tightening procedures can be performed successfully using a postoperative adjustment technique for the SO tendon.

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    • "Superior oblique surgery is one of the most challenging surgeries and requires a thorough knowledge of anatomy, extensive experience, and appropriate preoperative decision-making in view of possible complications and unpredictable outcomes. It includes various types, such as tucking, split tendon elongation, the Harada-Ito procedure, tendon plication, tenotomy, tenectomy, silicone tendon expander, and adjustable sutures.1–3 We aimed to identify the clinical scenarios in which surgery for the superior oblique muscle was preferred or required, to define our surgical preference for strabismus cases in which the superior oblique muscle was involved, and to analyze the surgical results. "
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    ABSTRACT: This review includes updated information regarding adjustable suture strabismus surgery for children and adults. Main themes in the literature reviewed in this article include the appropriate timing for the adjustment technique, appropriate anesthesia, recent modifications in adjustable strabismus surgery techniques, and future developments. Improved timing of adjustment, improved anesthesia, and newer surgical techniques allow strabismus surgeons to offer treatment options better suited to the needs of each strabismus patient.
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    ABSTRACT: To evaluate the outcomes of a superior oblique tendon spacer procedure using nonabsorbable adjustable sutures in patients with Brown syndrome. This noncomparative interventional case series includes 25 eyes of 25 patients with Brown syndrome. In all patients the superior oblique tendon was exposed; two nonabsorbable polyester sutures were placed 4 mm apart, and the tendon was cut. With the use of a slipknot, the cut ends of the tendon were separated 5 to 8 mm. Tendon separation was adjusted intraoperatively according to the exaggerated traction test and indirect ophthalmoscopy. Overall 25 eyes of 25 patients with mean age of 8.00 +/- 4.62 years were operated and followed for a mean period of 13.2 +/- 7.6 months (range, 3 to 30 months). Mean elevation in adduction improved from -3.96 before surgery to -0.67 (p < 0.001); mean hypotropia improved from 11.08(Delta) to 0.32(Delta) (p < 0.001). Two patients developed overcorrection, but recurrence was not observed in any case. The patients continued to improve over the follow-up period. The adjustable superior oblique tendon suture spacer procedure has favorable results and seems to be technically easier than a silicone expander procedure for Brown syndrome.
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