EFFICACY OF PRISM ADAPTATION IN ACQUIRED ESOTROPIA

回顾性研究表明，50%的外科患者获得性 内斜视患者通过一次手术获得良好的眼睛对准。 新证据 表明在术前使用棱镜，良好的眼睛对准可以 在约85%的手术患者中， 后天性内斜视 一项多中心、随机、前瞻性、临床 严格注意标准化和无偏倚结果的试验 评价建议确定：1.的总体有益效果 棱镜适配过程通过比较（a）棱镜适配响应器 对（B）那些患者进行了原始偏斜角度的手术 那些没有棱镜适应和手术的原始角度 偏差; 2.是否有获得性内斜视患者对棱镜有反应 通过对适配的棱镜进行操作， 角或原始偏差角; 3.是否有反应的患者 通过开发一种新的稳定的偏角， 手术结果优于对棱镜无反应的患者 适应; 4。某些输入变量是否有助于预测 哪些患者更有可能从棱镜适应中受益。 为了回答这些问题，一项双随机研究 被设计。 五分之三的病人会被选中 手术前进行棱镜调整。 五分之二的病人 根据常规检查测量的交叉量进行手术 技术. 在那些对棱镜有反应的病人中， 有手术的基础上所需的棱镜量，以稳定 其余的将根据交叉量进行手术 最初测量。 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， 年在美国。 如果能减少三分之二， 利用棱镜适应，总的美元节省将在 每年320万美元和480万美元。 莫尔兹比约也会 减少手术并发症的发生， 从学校或工作中损失的时间，心理创伤大大减少 给病人。

Retrospective studies indicate that 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 multicenter, 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 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 useful in predicting which patients are more likely to benefit from prism adaptation. In an effort to answer these questions a double randomization study has been designed. Three-fifths of the patients will be 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, 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.