THE EFFICACY OF PRISM ADAPTATION IN ACQUIRED ESOTROPIA

回顾性研究表明，只有50%的手术患者 后天性内斜视通过一次手术获得良好的眼位对准。 新 有证据表明，术前使用棱镜， 一次操作即可实现对准， 后天性内斜视的外科病人。 一个多通道的，随机的， 前瞻性临床试验，并仔细注意标准化和 提出了无偏的结果评价，以确定：1。整体 通过比较棱镜适配过程的有益效果 对于棱镜适应角进行手术的适应反应者，以及 棱镜适应无反应者，他们接受了原始角度的手术， 偏离（B）不具有棱镜适应且具有 手术矫正原有的偏斜角度; 2.患者是否 对棱镜适应有反应的后天性内斜视， 通过对棱镜适配角或初始角进行操作来校正 偏差; 3.对棱镜适应有反应的患者是否 开发新的稳定偏斜角，手术效果更好 与对棱镜适应没有反应的患者相比;以及4.是否 某些输入变量可用于预测哪些患者 可能会从棱镜适应中受益。 为了回答这些问题，一项双随机研究 被设计。 五分之三的患者将被随机选择， 在手术前进行棱镜调整。 五分之二的病人 将根据常规测量的交叉量进行手术 检查技术。 在那些对棱镜有反应的病人中， 一半的人将根据所需的棱镜数量进行手术， 稳定偏差，而其余的将根据 最初测量的交叉量。 如果棱镜适应确实导致更成功的手术， 在实现减少的长期目标方面具有重大影响 后天性内斜视的治疗费用和发病率。 大约2，500例后天性内斜视的再次手术， 在美国的一年。 如果能减少三分之二， 利用棱镜调整，每次行动的费用在2 000美元 和3,000美元（医院费用+医生费用），节省的总美元将 每年320万至480万美元。 莫尔蒂会 手术并发症也相应减少 发生，从学校或工作中损失的时间更少， 对病人造成心理创伤。

Retrospective studies indicate that only 50% of surgical patients with acquired esotropia achieve good eye alignment with one surgery. New evidence indicates that with the preoperative use of prisms, good eye alignment can be achieved with one operation in approximately 85% of surgical patients with acquired esotropia. A multicener, randomized, prospective, clinical trial with careful attention to standardization and unbiased outcome evaluation is proposed to determine: 1. The overall beneficial effect of the prism adaptation procedure by comparing (a) prism adaptation responders who have surgery for the prism adapted angle, and prism adaptation non-responders who have surgery for the original angle of deviation to (b) those patients who do not have prism adaptation and have surgery for the original angle of deviation; 2. Whether patients with acquired esotropia who respond to prism adaptation are more accurately corrected by operating for the prism adapted angle or the original angle of deviation; 3. Whether patients who respond to prism adaptation by developing a new stable angle of deviation, have a better surgical result than patients who do not respond to prism adaptation; and 4. Whether certain input variables are useul in predicting which patients are more likely to benefit from the prism adaptation. In an effort to answer these questions a double randomization study has been designed. Three-fifths of the patients will be randomly selected to go through prism adaptation prior to surgery. Two-fifths of the patients will have surgery based on the amount of crossing measured using routine examination techniques. Of those patients who respond to the prisms, one-half will have surgery based on the amount of prism required to stabilize the deviation while the rest will have surgery based on the amount of crossing originally measured. If prism adaptation does lead to more successful surgery, its adoption can have a significant effect in meeting the long term objective of decreasing the cost and morbidity for the treatment of acquired esotropia. Approximately 2,500 reoperations for acquired esotropia are performed each year in the United States. If these could be reduced by two-thirds through utilization of prism adaptation, with each operation costing between $2,000 and $3,000 (hospital cost + physican's fee), the total dollar saving would be between $3.2 million and $4.8 million per year. Morbidity would likewise be reduced, with proportionally fewer operative complications occurring, less time lost from school or work, and considerably less psychological trauma to the patient.