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Kenneth W. Wright - One of the best experts on this subject based on the ideXlab platform.
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Comparison of superior oblique tendon expander to superior oblique tenotomy for the management of superior oblique overaction and Brown Syndrome.
Journal of Pediatric Ophthalmology & Strabismus, 1992Co-Authors: Kenneth W. Wright, Min Bm, Park CAbstract: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)
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Superior oblique silicone expander for Brown Syndrome and superior oblique overaction.
Journal of Pediatric Ophthalmology & Strabismus, 1991Co-Authors: Kenneth W. WrightAbstract:Standard procedures for weakening the superior oblique muscle have been associated with significant complications in the treatment of superior oblique overaction and Brown Syndrome. This article presents a new technique for weakening the superior oblique muscle by lengthening the superior oblique tendon. Lengthening is accomplished by a nasal superior oblique tenotomy, and by inserting a segment of medical grade silicone 240 retinal band between the cut ends of the tendon. This technique was performed on 18 patients (30 eyes), 14 (26 eyes) with superior oblique overaction, and four (one eye each) with Brown Syndrome. Preoperatively, patients with superior oblique overaction demonstrated A-patterns between 20 prism diopters and 55 delta, and versions of +2 to +4 superior oblique overaction in at least one eye. Postoperatively, the A-pattern and overaction improved in each case, and 13 of the 14 patients had patterns 10 delta or less. Of the four patients with Brown Syndrome, three showed marked improvement of elevation in adduction, without consecutive superior oblique palsy. One had no improvement, even after a second procedure, consisting of superior oblique tenectomy; this case probably represents a non-superior oblique restriction (ie, a pseudo-Brown Syndrome). Based on these results, it appears that the silicone expander technique is useful in patients with superior oblique overaction and Brown Syndrome secondary to tight superior oblique tendon. This technique allows a predetermined degree of tendon separation and a graded weakening of the superior oblique muscle. Furthermore, by controlling the cut ends of the tendon, the procedure is easily reversible and there is ready access to the tendon should reoperation be necessary for residual overaction.
Jeong-min Hwang - One of the best experts on this subject based on the ideXlab platform.
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Combined Brown Syndrome and superior oblique palsy without a trochlear nerve: case report
BMC Ophthalmology, 2017Co-Authors: Hee Kyung Yang, Jae Hyoung Kim, Ji Soo Kim, Jeong-min HwangAbstract:Congenital Brown Syndrome is characterized by limited elevation particularly during adduction. The pathogenesis of congenital Brown Syndrome is still controversial. A 6-year-old boy had been tilting his head to the left since infancy. He showed right hypertropia (RHT) of 2 prism diopters (Δ) in the primary position. He showed RHT 6Δ in right gaze, RHT 2Δ in left gaze, RHT 12Δ in right head tilt, and orthotropia in left head tilt. The right eye showed limitation of elevation and depression on adduction, and the left eye showed overdepression on adduction. MR images showed an absent right trochlear nerve with a hypoplastic ipsilateral superior oblique muscle. Congenital Brown Syndrome may be associated with an absent trochlear nerve and hypoplastic superior oblique muscle suggesting an etiologic mechanism of congenital cranial dysinnervation disorder.
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Combined Brown Syndrome and superior oblique palsy without a trochlear nerve: case report
BMC Ophthalmology, 2017Co-Authors: Hee Kyung Yang, Jae Hyoung Kim, Ji Soo Kim, Jeong-min HwangAbstract:Background Congenital Brown Syndrome is characterized by limited elevation particularly during adduction. The pathogenesis of congenital Brown Syndrome is still controversial. Case presentation A 6-year-old boy had been tilting his head to the left since infancy. He showed right hypertropia (RHT) of 2 prism diopters (Δ) in the primary position. He showed RHT 6Δ in right gaze, RHT 2Δ in left gaze, RHT 12Δ in right head tilt, and orthotropia in left head tilt. The right eye showed limitation of elevation and depression on adduction, and the left eye showed overdepression on adduction. MR images showed an absent right trochlear nerve with a hypoplastic ipsilateral superior oblique muscle. Conclusions Congenital Brown Syndrome may be associated with an absent trochlear nerve and hypoplastic superior oblique muscle suggesting an etiologic mechanism of congenital cranial dysinnervation disorder.
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Magnetic resonance imaging in congenital Brown Syndrome
Graefe's Archive for Clinical and Experimental Ophthalmology, 2015Co-Authors: Jae Hyoung Kim, Jeong-min HwangAbstract:Aims Our aim was to elucidate the etiology of Brown Syndrome by evaluating the trochlea position, morphologic characteristics of the extraocular muscles including superior oblique muscle/tendon complex, and the presence of the cranial nerves (CN) III, IV, and VI using magnetic resonance imaging (MRI) in eight patients with unilateral congenital Brown Syndrome and one patient with bilateral congenital Brown Syndrome. Methods Nine consecutive patients diagnosed with congenital Brown Syndrome had a comprehensive ocular examination and MRI for the CN III, CN VI, and the extraocular muscles. Five of the nine patients underwent additional high resolution MRI for CN IV. The distance from the annulus of Zinn to the trochlea was measured. Results Normal sized CN III, IV, and VI, as well as all extraocular muscles, could be identified bilaterally in all patients with available MRI. The distance from the annulus of Zinn to the trochlea was the same in both eyes. Conclusions The findings for our patients, particularly in those who underwent additional high resolution MRI, did not provide evidence of a lack of CN IV as a cause of Brown Syndrome.
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Magnetic resonance imaging in congenital Brown Syndrome.
Graefe's Archive for Clinical and Experimental Ophthalmology, 2015Co-Authors: Jae Hyoung Kim, Jeong-min HwangAbstract:Aims Our aim was to elucidate the etiology of Brown Syndrome by evaluating the trochlea position, morphologic characteristics of the extraocular muscles including superior oblique muscle/tendon complex, and the presence of the cranial nerves (CN) III, IV, and VI using magnetic resonance imaging (MRI) in eight patients with unilateral congenital Brown Syndrome and one patient with bilateral congenital Brown Syndrome.
Joseph L Demer - One of the best experts on this subject based on the ideXlab platform.
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size of the oblique extraocular muscles and superior oblique muscle contractility in Brown Syndrome
Investigative Ophthalmology & Visual Science, 2015Co-Authors: Soh Youn Suh, Joseph L DemerAbstract:PURPOSE This study employed magnetic resonance imaging (MRI) to investigate possible size and contractility changes in the superior oblique (SO) muscle, and possible isometric hypertrophy in the inferior oblique (IO) muscle, resulting from abnormal mechanical loading in Brown Syndrome (BrS). METHODS High resolution orbital MRI was obtained in 4 congenital and 11 acquired cases of BrS, and compared with 44 normal subjects. Maximal cross-section areas and posterior partial volumes (PPVs) of the SO were analyzed in central gaze, supraduction, and infraduction [corrected] for the SO, and in central gaze only for the IO. RESULTS In congenital BrS, mean maximum SO cross-sectional areas were 24% and 20% less than normal in affected and unaffected eyes, respectively (P = 0.0002). Mean PPV in congenital BrS was also significantly subnormal bilaterally (29% and 34% less in affected and unaffected eyes, respectively, P = 0.001). However, SO muscle size and volume were normal in acquired cases. The SO muscle did not relax in supraduction in BrS, although there was normal contractile thickening in infraduction. The IO muscle had normal size bilaterally in BrS. CONCLUSIONS Congenital BrS may be associated with SO hypoplasia that could reflect hypoinnervation. However, unique isometric loading of oblique extraocular muscles due to restrictive hypotropia in adduction in BrS is generally not associated with changes in muscle bulk or in SO contractility. Unlike skeletal muscles, the bulk and contractility of extraocular muscles can therefore be regarded as independent of isometric exercise history. Restriction to elevation in BrS typically arises in the trochlea-tendon complex.
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high resolution magnetic resonance imaging demonstrates varied anatomic abnormalities in Brown Syndrome
Journal of Aapos, 2005Co-Authors: Rahul Bhola, Arthur L Rosenbaum, Maria Carolina Ortube, Joseph L DemerAbstract:Inroduction: Although Brown Syndrome classically is considered to be limited to the SO tendon sheath and trochlea, it does not always respond to SO surgery. We investigated mechanisms of Brown Syndrome by magnetic resonance imaging (MRI). Methods: Three patients with congenital and 8 with acquired Brown Syndrome were compared with matched normal subjects under a prospective protocol of high-resolution, multipositional orbital MRI using surface coils. Muscle size and contractility were determined using digital image analysis. Results: Five of 8 patients with acquired Brown Syndrome had a history of trauma or surgery and demonstrated extensive scarring, avulsion, or fracture of the trochlea. One of the 8 had a cyst in the SO tendon. One congenital and one acquired case demonstrated inferior displacement of the lateral rectus (LR) pulley in adduction, with a normal SO tendon–trochlear complex. Such cases of Brown Syndrome responded to surgical stabilization of the LR pulley. Two congenital cases had clinical findings of ipsilateral SO palsy confirmed on MRI by atrophy or absence of the SO belly. In congenital absence of the SO belly, the anterior tendon was present but terminated directly on the trochlea. Conclusion: High-resolution MRI demonstrates a variety of abnormalities in patients presenting with Brown Syndrome, including atrophy or absence of the SO belly. Management in Brown Syndrome should be tailored to the pathophysiology of the individual patient.
Emilio C Campos - One of the best experts on this subject based on the ideXlab platform.
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Steroid intra-trochlear injection for the treatment of acquired Brown Syndrome secondary to trochleitis
Graefe's Archive for Clinical and Experimental Ophthalmology, 2017Co-Authors: Giuseppe Giannaccare, Laura Primavera, Chiara Maiolo, Michela Fresina, Emilio C CamposAbstract:Purpose To evaluate the outcomes of early intra-trochlear steroid injections in patients with acquired Brown Syndrome secondary to trochleitis (ABSST). Methods Retrospective analysis from medical charts of patients diagnosed as affected by unilateral ABSST from January 2008 to June 2015, and treated according to our Institution protocol: intra-trochlear injection of 1ml of triamcinolone acetonide 40 mg/ml is performed under sterile conditions. In cases of no resolution/improvement within 1 month, further monthly injections are performed up to a maximum number of three. Non-responder patients after three injections undergo recession of the superior oblique muscle. Results Thirteen patients were diagnosed as affected by unilateral ABSST, and were included in the analysis (seven F, six M; median age at diagnosis 30.38 ± 25.56 years). The mean time interval from ABSST diagnosis to the first steroid injection was 7.84 ± 5.40 days (range 2–17). After a median number of 1.30 injections per patient, 11 patients (84.6% of the total) showed complete remission of symptoms and signs within 22.45 ± 13.85 days after the first injection. None of these responder patients referred to diplopia in primary gaze after injections. The remaining two non-responder patients after three injections underwent superior oblique muscle recession of 8.0 mm. Conclusions Early intra-trochlear steroid injections are effective in patients with acquired Brown Syndrome secondary to trochleitis, leading to a complete recovery of signs and symptoms in the majority of treated patients. Surgical treatment should be limited only to patients non-responding to serial steroid injections.
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steroid intra trochlear injection for the treatment of acquired Brown Syndrome secondary to trochleitis
Graefes Archive for Clinical and Experimental Ophthalmology, 2017Co-Authors: Giuseppe Giannaccare, Laura Primavera, Chiara Maiolo, Michela Fresina, Emilio C CamposAbstract:To evaluate the outcomes of early intra-trochlear steroid injections in patients with acquired Brown Syndrome secondary to trochleitis (ABSST). Retrospective analysis from medical charts of patients diagnosed as affected by unilateral ABSST from January 2008 to June 2015, and treated according to our Institution protocol: intra-trochlear injection of 1ml of triamcinolone acetonide 40 mg/ml is performed under sterile conditions. In cases of no resolution/improvement within 1 month, further monthly injections are performed up to a maximum number of three. Non-responder patients after three injections undergo recession of the superior oblique muscle. Thirteen patients were diagnosed as affected by unilateral ABSST, and were included in the analysis (seven F, six M; median age at diagnosis 30.38 ± 25.56 years). The mean time interval from ABSST diagnosis to the first steroid injection was 7.84 ± 5.40 days (range 2–17). After a median number of 1.30 injections per patient, 11 patients (84.6% of the total) showed complete remission of symptoms and signs within 22.45 ± 13.85 days after the first injection. None of these responder patients referred to diplopia in primary gaze after injections. The remaining two non-responder patients after three injections underwent superior oblique muscle recession of 8.0 mm. Early intra-trochlear steroid injections are effective in patients with acquired Brown Syndrome secondary to trochleitis, leading to a complete recovery of signs and symptoms in the majority of treated patients. Surgical treatment should be limited only to patients non-responding to serial steroid injections.
Umut Arslan - One of the best experts on this subject based on the ideXlab platform.
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Amblyopia and sensory features at initial presentation of Brown Syndrome: an issue to recognize
Eye, 2013Co-Authors: H T Sekeroglu, A S Sanac, E C Sener, Umut ArslanAbstract:Purpose To investigate the frequency of amblyopia and sensory features at initial presentation in patients who had unilateral congenital Brown Syndrome (BS) and to identify the potential risk factors for amblyopia in BS. Methods The study conducted with patients who had unilateral congenital BS. Patient demographics, visual acuity, refractive errors, amount of horizontal and vertical deviations, abnormal head position, fusion, and stereopsis were all reviewed. The main outcome measure was the frequency of amblyopia at initial presentation. Results The review identified 44 patients with BS (median age 5 years). The frequency of amblyopia was 15.9% (seven patients) in BS at initial presentation. Patient age ( P =0.297), ocular alignment at primary position ( P =0.693), anisometropia ( P =0.184), and stereoacuity ( P =0.061) were found to have no significant relation with amblyopia. The main associated risk factor was the absence of sensory fusion ( P =0.013). Conclusions Amblyopia may be encountered among patients with BS, and may be related to binocularity of the patient. Its recognition may be a critical step during the treatment planning and may determine presumably the success of future therapies.
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Amblyopia and sensory features at initial presentation of Brown Syndrome: an issue to recognize.
Eye, 2013Co-Authors: Hande Taylan Şekeroğlu, Ali Şefik Sanaç, Emin Cumhur Şener, Ersin Muz, Umut ArslanAbstract:Amblyopia and sensory features at initial presentation of Brown Syndrome: an issue to recognize
