Nishikawa Noriko, Kawaguchi Yuriya, Fushitsu Rui
Department of Ophthalmology, Asahikawa Medical University, Asahikawa.
Strabismus. 2023 Mar;31(1):9-16. doi: 10.1080/09273972.2022.2143824. Epub 2022 Nov 21.
To investigate the clinical factors influencing the prism adaptation response of acquired non-accommodative comitant esotropia (ANAET) and evaluate the surgical outcomes.
Retrospective observational study.
This study assessed patients with ANAET who underwent strabismus surgery based on the results of a short prism adaptation test (PAT). Patients wore Fresnel trial prisms based on alternate prism cover tests in outpatient clinics. The cover test was then performed after 15-20 minutes; if the deviation increased, the power of the prism was increased to neutralize the angle. The test was repeated until the angle was stable. Patients were classified as either prism builders (angle increased by ≥ 10 prism diopters [PD] compared with the entry angle) or prism non-builders (angle increased by < 10 PD). The following clinical characteristics were noted: age at onset, age at surgery, duration of esotropia, refractive error, angle of deviation, presence or absence of intermittent esotropia at near, and pre- and postoperative sensory status.
A total of 41 patients (median age, 15.4 years) were evaluated. The mean (standard deviation) spherical equivalent refractions were -3.03 (3.33) diopters (D) and -3.05 (3.23) D in the right and left eyes, respectively. Twenty-seven (66%) patients were prism builders. The prism builders had greater myopia (builders vs. non- builders, right eye: -3.97 [2.97] vs. -1.22 [3.33] D, P = .01; left eye: -4.08 [2.78] vs. -1.07 [3.20] D; P = .003), lower angle of deviation at near (median [interquartile range] 30.0 [20.0, 35.0] vs. 42.5 [35.0, 49.4] PD; P = .009), much more preoperative intermittent esotropia or esophoria at near (44% vs. 7%, P = .03) and diplopia (96% vs. 64%, P = .01), and better postoperative stereoacuity (50 [40, 110] vs. 100 [60, 400] arcsec, P = .02) than the prism non-builders. The overall success rate was 83%, without a significant difference between the two groups (builders vs. non-builders, 89% vs. 71%, P = .21).
In cases of myopic refractive error, a small entry angle with intermittency at near, and good binocularity, it is recommended that surgery is performed based on prism-adapted angle to prevent under-correction.
探讨影响后天性非调节性共同性内斜视（ANAET）棱镜适应反应的临床因素，并评估手术效果。
回顾性观察研究。
本研究基于短棱镜适应试验（PAT）结果，对接受斜视手术的ANAET患者进行评估。患者在门诊根据交替棱镜遮盖试验佩戴菲涅尔试验棱镜。15 - 20分钟后进行遮盖试验；如果斜视度增加，则增加棱镜度数以中和角度。重复该试验直至角度稳定。患者分为棱镜增强者（与初始角度相比，角度增加≥10棱镜度[PD]）或非棱镜增强者（角度增加<10 PD）。记录以下临床特征：发病年龄、手术年龄、内斜视持续时间、屈光不正、斜视角度、近距间歇性内斜视的有无以及术前和术后的感觉状态。
共评估了41例患者（中位年龄15.4岁）。右眼和左眼的平均（标准差）等效球镜度分别为-3.03（3.33）屈光度（D）和-3.05（3.23）D。27例（66%）患者为棱镜增强者。与非棱镜增强者相比，棱镜增强者近视程度更高（增强者与非增强者，右眼：-3.97[2.97] vs. -1.22[3.33]D，P = 0.01；左眼：-4.08[2.78] vs. -1.07[3.20]D；P = 0.003），近距斜视度更低（中位数[四分位间距]30.0[20.0, 35.0] vs. 42.5[35.0, 49.4]PD；P = 0.009），术前近距更多间歇性内斜视或隐斜（44% vs. 7%，P = 0.03）和复视（96% vs. 64%，P = 0.01），术后立体视锐度更好（50[40, 110] vs. 100[60, 400]弧秒，P = 0.02）。总体成功率为83%，两组之间无显著差异（增强者与非增强者，89% vs. 71%，P = 0.21）。
对于近视性屈光不正、近距小初始角度且有间歇性以及双眼视功能良好的病例，建议根据棱镜适应后的角度进行手术以防止矫正不足。
