Joo Hye Jun, Kim Seong-Joon
Department of Ophthalmology, Seoul National University Hospital and College of Medicine, 101, Daehak-Ro Jongno-Gu, Seoul, South Korea, 03080.
Seoul National University College of Medicine, Seoul, South Korea.
Graefes Arch Clin Exp Ophthalmol. 2025 Mar;263(3):857-865. doi: 10.1007/s00417-024-06662-z. Epub 2024 Oct 15.
We aimed to investigate the effects of Fresnel prism treatment for small-angle esotropia (≤ 20 prism diopters [PD]) with fixation preference.
We included 32 patients with remaining esotropia ≤ 20 PD measured using the simultaneous prism and cover test (SPCT) after full refractive error correction. Fresnel prism was applied to make patients orthotropic with glasses. Treatment was discontinued if remaining esotropia ≤ 4 PD was sustained during two consecutive follow-ups (2-month intervals) or if the angle continued to increase with prism adaptation. Patients were divided into treatment success and failure groups. Treatment success was defined by motor and visual acuity (VA) aspects. Criteria for motor success was residual esotropia ≤ 8 PD in patients with initial esotropia > 8 PD and a 30% decrease of esotropia in those with initial esotropia ≤ 8 PD. VA success was improvement of > 0.2 logMAR in the non-dominant eye.
The initial esodeviation angle was 6.92 ± 4.66 PD at distance and 10.53 ± 5.58 at near. The logMAR VA was 0.10 ± 0.13 and 0.26 ± 0.20 in the dominant and non-dominant eye, respectively. Among the 32 patients, 14 showed motor success. Among 26 patients whose VA could be measured, 15 showed VA success. Factors influencing motor success were a small amount of maximum prescribed Fresnel prism, less frequent need for Fresnel prism adaptation, and high percentage of achieving orthotropia with Fresnel prism treatment. VA success was influenced by low frequency of anisometropia and the small amount of maximum prescribed Fresnel prism.
Fresnel prism could be a non-invasive treatment option for some patients with small-angle esotropia with fixation preference.
What is known The optimal approach for addressing small-angle esotropia is a topic of debate. Not much research has been conducted on Fresnel prism treatment in patients with small-angle esotropia. What is new Motor success and visual acuity improvement were observed in some patients undergoing Fresnel prism treatment. Factors contributing to motor success were the small maximum angle of esodeviation, the less frequent necessity for Fresnel prism adaptation, and the achievement of orthotropia during Fresnel prism treatment. Visual acuity improvement was hindered by the presence of anisometropia and the large maximum prescribed amount of Fresnel prism. Fresnel prism treatment can be used as a treatment option for some patients with small-angle esotropia with fixation preference.
我们旨在研究菲涅尔棱镜治疗伴有注视偏好的小角度内斜视（≤20棱镜度[PD]）的效果。
我们纳入了32例患者，这些患者在完全矫正屈光不正后，使用同时三棱镜和遮盖试验（SPCT）测量的残余内斜视≤20 PD。应用菲涅尔棱镜使患者戴眼镜时眼位正位。如果在连续两次随访（间隔2个月）期间残余内斜视≤4 PD持续存在，或者随着棱镜适应角度继续增加，则停止治疗。患者被分为治疗成功组和失败组。治疗成功从运动和视力（VA）方面进行定义。运动成功的标准是初始内斜视>8 PD的患者残余内斜视≤8 PD，初始内斜视≤8 PD的患者内斜视减少30%。视力成功是指非优势眼的logMAR视力提高>0.2。
远距离初始内斜视角为6.92±4.66 PD，近距离为10.53±5.58 PD。优势眼和非优势眼的logMAR视力分别为0.10±0.13和0.26±0.20。在32例患者中，14例显示运动成功。在26例可测量视力的患者中，15例显示视力成功。影响运动成功的因素是最大处方菲涅尔棱镜量少、菲涅尔棱镜适应需求频率低以及菲涅尔棱镜治疗实现正位的百分比高。视力成功受屈光参差频率低和最大处方菲涅尔棱镜量少的影响。
对于一些伴有注视偏好的小角度内斜视患者，菲涅尔棱镜可能是一种非侵入性的治疗选择。
已知内容 解决小角度内斜视的最佳方法是一个有争议的话题。关于菲涅尔棱镜治疗小角度内斜视患者的研究不多。新发现 在一些接受菲涅尔棱镜治疗的患者中观察到运动成功和视力改善。导致运动成功的因素是内斜视最大角度小、菲涅尔棱镜适应必要性低以及菲涅尔棱镜治疗期间实现正位。屈光参差的存在和菲涅尔棱镜最大处方量大会阻碍视力改善。菲涅尔棱镜治疗可作为一些伴有注视偏好的小角度内斜视患者的治疗选择。
