Brown’s
Syndrome (BS) is an eye disorder characterized by abnormalities in the
eye's ability to move. Specifically, the ability to look up and in is
affected by a problem in the superior oblique muscle/tendon. The condition may
be present at birth (congenital) or it may develop following surgery or as a
result of inflammation or a problem with development. Some cases are constant
while others are intermittent.
BS can be
classified into mild, moderate (if a downshoot in adduction is present) and
severe (if hypotropia in the primary position is present) forms and its treatment
recommendations vary depending on the cause and severity of the condition. Spontaneous
improvement has been reported in several studies, so surgery is reserved for a
minority of cases. The purpose of this paper was to review the characteristics,
natural history and treatment of this pathology and present the experience of
the Instituto de Oftalmologia Dr. Gama Pinto (IOGP).
A consecutive
retrospective series of BS patients seen at the Strabismus Department of IOGP
between 1983 and 2014 was reviewed. All patients with complete clinical data
were included in this study. The epidemiologic characteristics, clinical
features, treatment, and clinical progression were reviewed. The
deviations were measured using the prismatic Cover Test. Visual acuity was
evaluated with Snellen optotypes scale, Snellen EE scale or Sheridan test,
according to age and cooperation of the patient.
Thirty-nine cases
were selected, with a mean age at first diagnosis of 6.5 years. Of the
thirty-nine cases, 6 were iatrogenic and the remainder idiopathic. Thirty-six
cases were followed for a mean period of 6.1 years. Surgical intervention for
BS was performed in 11 patients, using different approaches. Of these, 9 cases
were considered successful. The remaining 25 cases were kept under observation
without surgery, of which 17 showed spontaneous improvement and the other 7
remained unchanged. The surgical success rate was 82%, which demonstrates the
good efficacy of the surgery despite the complexity and variety of
pathophysiological mechanisms of the syndrome. In the patients kept under
observation there was spontaneous improvement in 68%, confirming that a
conservative approach seems to be adequate in most cases.
In conclusion, our
experience seems to confirm that the spontaneous improvement of BS is common.
This fact should be considered when evaluating BS. Furthermore, when surgery is
required, planning may be complex, but the results are usually good.
Article by Pedro
Filipe Rodrigues, et al, from Instituto de Oftalmologia Dr. Gama Pinto, Lisbon,
Portugal.
Full access: http://mrw.so/52d3eK
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