title: Surgical outcome after prism adaptation for esotropia with a distance-near disparity.
abstract: BACKGROUND
  Prism adaptation for patients with esotropia and a distance-near disparity is controversial. The purpose of this study was to evaluate the surgical outcome for patients who underwent prism adaptation for esotropia with a distance-near disparity and determine whether both preoperative sensory and motor fusion are necessary to determine surgical success.
  
  
  METHODS
  The medical records of 65 prism-adapted patients with a distance-near disparity of 9 PD or more were reviewed. Prism responders had a fusion response to near Worth 4-dot test and a deviation with prisms of 8 PD or less of esotropia at near, and 5 PD or less of exotropia at distance, or both. The same criteria were used postoperatively to assess a successful surgical outcome. Patients were operated for the near angle or greater than the near angle.
  
  
  RESULTS
  Fifty-eight of 65 patients (89%) demonstrated fusion with prisms. Twenty of 65 patients (31%) had increased deviations that were greater than their original near angle (prism builders). Eleven percent (7 of 65) had no fusion. Postoperatively, 88% (51 of 58) of all fusers, 95% (18 of 19) of prism builders, and 71% (5 of 7) of nonfusers had a good surgical outcome of 8 PD or less of esotropia at near, 5 PD or less of exotropia at distance, or both.
  
  
  CONCLUSIONS
  Prism response for distance-near disparity esotropia is a good indicator of postoperative outcome. Responders to prism adaptation had a better surgical outcome compared with nonresponders. In particular, prism adaptation aids in detecting those patients who will benefit from larger amounts of surgical correction.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52245-1091, USA. pamela-kutschke@uiowa.edu
authors.forename: P J
authors.initials: PJ
authors.lastname: Kutschke
authors.forename: R V
authors.initials: RV
authors.lastname: Keech
mesh_terms: D000221:Adaptation, Ocular; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004948:Esotropia / Q000601:surgery*; D005139:Eyeglasses; D006801:Humans; D009801:Oculomotor Muscles / Q000601:surgery*; D010468:Perceptual Disorders / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015357:Vision Disparity; D015348:Vision, Binocular