EFFICACY OF PRISM ADAPTATION IN ACQUIRED ESOTROPIA

只有50%的后天性内斜视手术患者获得良好的视力 与一次手术对齐。 有证据表明，术前使用 棱镜，良好的眼睛对准可以实现一个操作， 约85%的手术患者。 一项多中心、随机、 前瞻性临床试验，并仔细注意标准化和 建议进行公正的结果评价，以确定： 1.后天性内斜视的手术效果较好， 它们具有术前棱镜适应性。 2.如果对棱镜适应反应的患者更准确地 通过对棱镜适配角或初始角进行操作来校正 偏差 3.如果存在输入变量的聚类（例如，年龄、偏差大小， 感觉状态、屈光不正或AC/A比率），有助于预测 患者更可能对棱镜适应测试作出反应。 三分之二的病人将被随机挑选通过棱镜 手术前的适应。 三分之一的病人将接受手术 根据使用常规检查测量的交叉数量 技术. 在对棱镜有反应的患者中， 根据稳定偏斜所需的棱镜量进行手术; 其余的将根据最初的穿越量进行手术， 测定了 如果棱镜适应导致更成功的手术， 在降低治疗成本和发病率方面具有显著效果 后天性内斜视 约2 500例购置的 在美国，每年都有一个内斜视手术，如果这些手术减少两个 三分之一通过使用棱镜调整，每项业务都计算费用 在2，000美元到3，000美元之间，节省的美元将在320万美元之间 每年480万美元。 死亡率会降低， 手术并发症的发生，减少了上学和工作的时间， 对患者、家属和医生的心理创伤更小。

Only 50% of surgical patients with acquired esotropia achieve good eye alignment with one surgery. Evidence indicates that with preoperative use of prisms, good eye alignment can be achieved with one operation in approximately 85% of surgical patients. A multicenter, randomized, prospective, clinical trial with careful attention to standardization and unbiased outcome evaluation is proposed to determine: 1. The surgical result in patients with acquired esotropia is better if they have preoperative prism adaptation. 2. If patients who respond to prism adaptation are more accurately corrected by operating for the prism adapted angle or the original angle of deviation. 3. If there are clusters of input variables, (e.g. age, size of deviation, sensory status, refractive error, or AC/A ratio) that help predict which patients are more likely to respond to the prism adaptation test. Two thirds of the patients will be randomly selected to go through prism adaptation prior to surgery. One-third of the patients will have surgery based on the amount of crossing measured using routine examination techniques. Of patients who respond to the prisms, one-half will have surgery based on the amount of prism required to stabilize the deviation; the rest will have surgery based on the amount of crossing originally measured. If prism adaptation leads to more successful surgery, its adoption can have a significant effect in decreasing the cost and morbidity for the treatment of acquired esotropia. Approximately 2,500 re-operations for acquired esotropia are performed each year in the U.S. If these are reduced by two thirds through utilization of prism adaptation with each operation costing between $2,000 and $3,000, the dollar saving would be between $3.2 million and $4.8 million per year. Morbidity would be reduced, with fewer operative complications occurring, less time lost from school and work, and less psychological trauma to the patient, family and physician.