title: The one-year surgical outcome after prism adaptation for the management of acquired esotropia.
abstract: OBJECTIVE
  To report the 1-year motor and sensory outcomes for patients with acquired comitant esotropia managed with preoperative prism adaptation.
  
  
  METHODS
  Patients entered a multicenter randomized prospective evaluation of prism adaptation before strabismus surgery. Prism responders were randomized to surgery with the target angle based on either the entry angle or the adapted angle of esotropia. Three hundred five patients (92 percent of cohort) completed 1-year postoperative follow-up.
  
  
  RESULTS
  The overall motor success rate for all patients in the study was 74 percent. Prism responders operated on for the adapted esotropic target angle had a satisfactory motor outcome more often than those operated on for the entry angle, 90 percent compared with 75 percent (P = 0.04). Significant predictors of a satisfactory motor outcome after surgery were prism adaptation, female sex, and hyperopia greater than or equal to +3.00 D. Prism responders operated on for the adapted angle showed fusion of the Worth 4-dot at substantially more often than did those operated on for the entry angle, 75 percent compared with 60 percent (P = 0.12).
  
  
  CONCLUSIONS
  Prism adaptation significantly improves the 1-year motor outcome after esotropia surgery in prism responders. There is no increase in the number of overcorrections. These results confirm the value of allotting the extra time and potential expense needed for this technique.
authors.affiliation: Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287-9009, USA.
authors.forename: M X
authors.initials: MX
authors.lastname: Repka
authors.forename: J E
authors.initials: JE
authors.lastname: Connett
authors.forename: W E
authors.initials: WE
authors.lastname: Scott
mesh_terms: D000221:Adaptation, Ocular; D002648:Child; D002675:Child, Preschool; D004948:Esotropia / Q000503:physiopathology / Q000601:surgery*; D005139:Eyeglasses; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome