Ela-Dalman Noa, Velez Guillermo, Thacker Neepa, Britt Michelle T, Velez Federico G
Jules Stein Eye Institute, University of California, Los Angeles, California 90095, USA.
J AAPOS. 2006 Dec;10(6):561-4. doi: 10.1016/j.jaapos.2006.09.011.
Preoperative prism adaptation and the maximum motor fusion test reduce the risk of postoperative undercorrection, overcorrection, and bifocal requirements in acquired esotropia. The purpose of our study is to determine the efficacy of the maximum motor fusion test followed by a short prism adaptation test in patients with acquired esotropia undergoing bilateral medial rectus muscle recession.
We undertook a retrospective review of 29 subjects with acquired esotropia without history of amblyopia, previous strabismus surgery, use of bifocals, pattern anisotropia, dissociated vertical deviation, or oblique muscle dysfunction. All subjects underwent bilateral medial rectus muscle recessions based on the distance angle of deviation measured with the maximum motor fusion test followed by prism adaptation test. Alternate prism and cover testing was performed after 1 hour of prism adaptation to determine the angle of deviation for surgical correction.
The age at surgery was 4.5 +/- 1 years. The preoperative angle of deviation at distance was 20.4 +/- 4.2(delta). It increased to 36.2 +/- 4.2(delta) after the maximum motor fusion test followed by 1 hour of prism adaptation testing. The final preoperative angle of deviation post motor fusion test-prism adaptation test was significantly larger than the initial angle of deviation (p < 0.0001). The final postoperative deviation at distance was 1.3 +/- 3.3(delta), and 5.2 +/- 1.5(delta) at near. Postoperative follow up was 18 +/- 2.6 months (range, 13-24 months).
The combination of maximum motor fusion and preoperative prism adaptation allowed increased amounts of medial rectus muscle muscle recession, decreasing the risk of postoperative undercorrection without increasing the risk of overcorrection.
术前棱镜适应和最大运动融合试验可降低后天性内斜视术后欠矫、过矫及双焦点需求的风险。我们研究的目的是确定在接受双侧内直肌后徙术的后天性内斜视患者中，最大运动融合试验后进行短时间棱镜适应试验的疗效。
我们对29例后天性内斜视患者进行了回顾性研究，这些患者无弱视史、既往斜视手术史、双焦点使用史、斜视性屈光不正、分离性垂直偏斜或斜肌功能障碍。所有患者均根据最大运动融合试验测量的远距离偏斜角度，随后进行棱镜适应试验，进行双侧内直肌后徙术。在棱镜适应1小时后进行交替棱镜遮盖试验，以确定手术矫正的偏斜角度。
手术年龄为4.5±1岁。术前远距离偏斜角度为20.4±4.2（三棱镜度）。在最大运动融合试验后进行1小时棱镜适应试验后，该角度增加到36.2±4.2（三棱镜度）。最大运动融合试验-棱镜适应试验后的最终术前偏斜角度显著大于初始偏斜角度（p<0.0001）。术后远距离最终偏斜角度为1.3±3.3（三棱镜度），近距离为5.2±1.5（三棱镜度）。术后随访时间为18±2.6个月（范围13 - 24个月）。
最大运动融合和术前棱镜适应相结合，可增加内直肌后徙量，降低术后欠矫风险，且不增加过矫风险。
