A randomized comparison of prism adaptation and augmented surgery in the surgical management of esotropia associated with hypermetropia.

OBJECTIVE

To compare both motor and sensory surgical outcomes for patients with esotropia associated with hypermetropia managed with an augmented surgery based on the average of the near deviation with and without correction vs preoperative prism adaptation.

METHODS

Forty-three patients with esotropia associated with hypermetropia entered a randomized prospective evaluation of augmented surgery (group A, 27 patients) versus prism adaptation (group P, 16 patients). The formula for augmenting the amount of the rectus muscle recession was based on the average of the near deviation with and without correction in group A, and the prism-adapted angle of deviation in group P.

RESULTS

In group A, postoperative deviations of 8 prism diopters (delta) or less at distance and at near were achieved in 24 patients (88%), and in 22 patients (81%), respectively. In nine prism responder patients, postoperative deviations of 8 delta or less at distance and at near were achieved in eight patients (89%). In seven nonresponder patients, postoperative deviations of 8 delta or less at distance and at near were achieved in six patients (86%). No significant difference between the two groups in terms of near and distance deviation at 1 and 3 months postoperatively were noted.

CONCLUSION

No significant difference existed in the motor outcomes between the two groups, or between the prism responder and prism nonresponder groups. Further detailed studies must be made in a large number of patients.