Tendon Expansion with Fascia Lata in Treatment of A-pattern Strabismus Due to Superior Oblique Overaction

Background: In 1991, Wright described a superior oblique expander procedure for browns syndrome and superior overaction with good results. Originally, this procedure has been performed with silicone band expander. The aim of this study was to report the results of treatment of a series of patients with Apattern strabismus associated with overacting superior oblique muscle using the fascia lata tendon expander technique. Methods: A total of 12 patients with bilateral overaction of the superior oblique muscle and A-pattern strabismus were treated with bilateral superior oblique lengthening with fascia lata according to the values recommended by Wright. Fascia lata was harvested through a lineal incision on the lateral aspect of the patients' thigh. Results: The follow-up was 4 to 51 months (mean, 28.8 ± 20.7 months). Mean superior oblique overaction improved from 3.5 ± 0.8 before surgery to 0.8 ± 0.9 after surgery (P<0.001). Mean A-pattern improved from 26.4 ± 8.5 PD to 1.7 ± 7 PD (P<0.001), and subjective intorsion improved from 6 ± 0.7 degree to 0.3 ± 1.1 degree (P<0.001). One patient developed overcorrection. None of the patients developed recurrence. Conclusion: The fascia lata tendon spacer is a useful procedure in the treatment of A-pattern strabismus due to superior oblique overaction. This technique may be superior to posterior tenectomy because of less incidence of superior oblique overaction recurrence; however, the operation time is longer. Iran J Med Sci 2008; 33(3): 150-154.