Abstract
Purpose: To report the 1-year motor and sensory outcomes for patients with acquired comitant esotropia managed with preoperative prism adaptation. Methods: Patients entered a multicenter randomized prospective evaluation of prism adaptation before strabismus surgery. Prism responders were randomized to surgery with the target angle based on either the entry angle or the adapted angle of esotropia. Three hundred five patients (92% of cohort) completed 1-year postoperative follow-up. Results: The overall motor success rate for all patients in the study was 74%. Prism responders operated on for the adapted esotropic target angle had a satisfactory motor outcome more often than those operated on for the entry angle, 90% compared with 75% (P = 0.04). Significant predictors of a satisfactory motor outcome after surgery were prism adaptation, female sex, and hyperopia greater than or equal to +3.00 D. Prism responders operated on for the adapted angle showed fusion of the Worth 4-dot at substantially more often than did those operated on for the entry angle, 75% compared with 60% (P = 0.12). Conclusion: Prism adaptation significantly improves the 1-year motor outcome after esotropia surgery in prism responders. There is no increase in the number of overcorrections. These results confirm the value of allotting the extra time and potential expense needed for this technique.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 922-928 |
| Number of pages | 7 |
| Journal | Ophthalmology |
| Volume | 103 |
| Issue number | 6 |
| DOIs | |
| State | Published - 1996 |
Bibliographical note
Funding Information:(PAS) was a prospective randomized multicenter clinical trial supported by the National Eye Institute. This project used a standardized table for amounts of surgical recession and resection, based on the angle of deviation with distance fixation. The PAS showed that preoperative prism adaptation significantly improved the chance of postoperative surgical alignment for patients with acquired esotropia.8
Funding Information:
Originally received: October 5, 1995. Revision accepted: February 27, 1996. I Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore. 2 Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis. 3 Department of Ophthalmology, The University ofIowa Hospitals and Clinics, Iowa City. Supported in part by the National Eye Institute, National Institutes of Health (EY 053303, EY 053224, EY 053297), Bethesda, Maryland. Reprint requests to Michael X. Repka, MD, Wilmer BI-35, The Johns Hopkins Hospital, 600 North Wolfe St, Baltimore, MD 21287-9009.