Effect of prism adaptation in patients with partially accommodative esotropia: clinical findings and surgical outcomes
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Effect of prism adaptation in patients with partially accommodative esotropia: clinical findings and surgical outcomes Yeonji Jang 1 & Haeng-Jin Lee 2 & Jae Ho Jung 1,3 & Seong-Joon Kim 1,3 Received: 13 May 2020 / Revised: 10 August 2020 / Accepted: 16 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To assess the effects of prism adaptation on the surgical outcomes of individuals with partially accommodative esotropia (PAET). Methods The medical records of 51 patients with PAET who were managed surgically at single referral center were retrospectively reviewed. Patients were divided into two groups according to prism adaptation. Data about sex, age, initial angle of deviation, final angle of deviation, stereoacuity, surgical dosage, and follow-up periods were collected. The main outcome of this study was motor outcomes at 12 months. Results Eighteen patients had a history of prism adaptation (PA group) and 33 did not (augmented surgery group, AS group). One year after surgery, 12 (66.7%) patients in the PA group and 21 (63.6%) in the AS group achieved an angle of deviation less than 5 PD. The surgical success rate in both groups did not significantly differ (p = 1). After the first prism adaptation test, six patients had an angle of deviation similar to the previous angle; however, 12 patients had larger angle, and consequently required additional prism (prism builder). Two (33.3%) patients who were prism non-builders had deviation less than 5 PD during the final visit. However, among the prism builders, four (57.1%) and five (100%) patients who had prism added once and more than once, respectively, had less than 5 PD deviation during the final visit (p = 0.03). Conclusion No significant differences were observed in terms of surgical outcomes between both groups. Nonetheless, in PA group, prism builders have better surgical outcomes than non-builders. Keywords Partially accommodative esotropia . Prism adaptation . Surgical outcomes . Augmented surgery
Introduction The surgical target angle in patients with partially accommodative esotropia (PAET) is challenging to identify. Prism adaptation and augmented surgery are methods used to improve surgical outcomes [1, 2]. In the prism adaptation study (PAS) research group, prism adaptation significantly improves motor outcome at
* Seong-Joon Kim [email protected] 1
Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
2
Department of Ophthalmology, Jeonbuk National University Hospital, Jeonju, South Korea
3
Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
1 year after esotropia surgery in prism responders, and the number of overcorrections does not increase [3, 4]. By contrast, previous studies have shown a lower incidence of undercorrections in augmented surgery than in conventional surgery. However, augmented surgery always has a risk for overcorrections due to its uncertainty [2, 5]. In addition, there is no standard augmented surger
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