Quigley Clare, Cairns Maria, McElnea Elizabeth, Doyle Fergus, McCance John, Mullaney Paul
Department of Ophthalmology, Galway University Hospital, Galway, Ireland.
Department of Ophthalmology, Sligo Regional Hospital, Sligo, Ireland.
J AAPOS. 2017 Apr;21(2):157-159.e1. doi: 10.1016/j.jaapos.2016.10.007. Epub 2017 Feb 14.
The prism adaptation test (PAT) is a preoperative tool that may fine-tune surgical dosage and reduce under- and overcorrection in pediatric partially accommodative esotropia; however, it is resource intensive and the benefits are uncertain. PAT involves correction of esodeviation with prisms, with subsequent assessment for and quantification of change in angle of esodeviation, thereby augmenting the surgical target angle in a subset of patients. We evaluated PAT response and postoperative outcomes in a cohort of children who underwent bilateral medial rectus recession and found that 36% of patients showed a requirement for increase of prism dosage to retain orthotropia during PAT; these patients did better than those whose deviation was stable, with postoperative rate of motor success (defined as ≤10 esotropia) of 100% versus 56%. PAT may be a useful positive prognostic test, and it also identifies a substantial patient population who may avoid undercorrection, the prism builders. However, this cohort may do better postoperatively regardless of the target angle for surgery. Additional randomized studies are required to demonstrate definitive benefit of PAT. Identification of the builder phenotype prior to commencing adaptation may reduce the workload involved in the PAT technique.
三棱镜适应试验（PAT）是一种术前工具，可对手术剂量进行微调，并减少小儿部分调节性内斜视的矫正不足和过度矫正；然而，该试验资源消耗大，其益处尚不确定。PAT包括用三棱镜矫正内斜视，随后评估并量化内斜视角度的变化，从而增加部分患者的手术目标角度。我们评估了一组接受双侧内直肌后徙术儿童的PAT反应和术后结果，发现36%的患者在PAT期间需要增加三棱镜剂量以保持正位；这些患者比斜视度数稳定的患者效果更好，术后运动成功（定义为内斜视≤10△）率分别为100%和56%。PAT可能是一种有用的阳性预后试验，它还能识别出大量可能避免矫正不足的患者群体，即三棱镜增强者。然而，无论手术目标角度如何，这一群体术后可能效果更好。需要更多随机研究来证明PAT的明确益处。在开始适应之前识别增强者表型可能会减少PAT技术的工作量。
