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Kim and Park: Outcomes of Augmented Surgery Performed after Simplified Prism Adaptation Testing in Patients with Intermittent Exotropia
Original Article

Journal of the Korean Ophthalmological Society 2019; 60(12): 1257-1262.

Published online: 17 December 2019

DOI: https://doi.org/10.3341/jkos.2019.60.12.1257

Outcomes of Augmented Surgery Performed after Simplified Prism Adaptation Testing in Patients with Intermittent Exotropia

Mijeong Kim, MD, Soochul Park, MD, PhD

Saevit Eye Hospital, Goyang, Korea.

Address reprint requests to Soochul Park, MD, PhD. Saevit Eye Hospital, #1065 Jungang-ro, Ilsandong-gu, Goyang 10447, Korea. Tel: 82-31-900-7700, Fax: 82-31-900-7777, psc1245@gmail.com

Received 23 September 2019       Revised 18 October 2019       Accepted 6 December 2019

©2019 The Korean Ophthalmological Society

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We explored whether the deviation angle in patients with intermittent exotropia was greater when the prism adaptation test was used rather than the prism cover test.

Methods

From January 2013 to December 2017, we performed the prism cover and adaptation tests on patients with intermittent exotropia. If the deviation angle increased by more than 5 PD after the prism adaptation test, surgery was performed. The outcomes of patients followed-up for more than 1 year after surgery were analyzed retrospectively.

Results

In total, 76 of 100 patients (76.0%) exhibited deviation angle increases of over 5 PD, the mean increase was 9.8 ± 6.3 prism diopters (PD) for near vision and 3.6 ± 3.5 PD for distance vision. Satisfactory motor alignment was achieved in 57 patients; 42 were undercorrected and 1 was overcorrected. The success rate was 62.5% in the non-responder group (n = 24, patients in whom the deviation angle did not increase after prism adaptation) and 68.9% in the full augmentation group (n = 45, in whom the deviation angle was increased). In the partial augmentation group (n = 31), where the surgical target was a 50% increase in the deviation angle, the success rate was lower than in the other groups.

Conclusions

The preoperative prism adaptation test can be used to determine the angle of deviation and improves the surgical outcomes of patients with intermittent exotropia.

Keywords: Intermittent exotropia, Prism adaptation test, Surgery

Figures and Tables

Table 1

Amount of surgical recession and resection according to deviation

jkos-60-1257-i001

PD = prism diopters; MR = medial rectus muscle; LR = lateral rectus muscle.

Table 2

Comparison of clinical features between PAT responders and non-responders

jkos-60-1257-i002

Values are presented as mean ± standard deviation.

PAT = prism adaptation test; BCVA = best corrected visual acuity; logMAR = logarithm of minimal angle of resolution; APCT = alternativeprism cover test; PD = prism diopters.

*Independent t-test.

Table 3

Comparison of clinical features between success group and undercorrection group

jkos-60-1257-i003

Values are presented as mean ± standard deviation unless otherwise indicated.

BCVA = best corrected visual acuity; logMAR = logarithm of minimal angle of resolution; APCT = alternative prism cover test; PD = prismdiopters; PAT = prism adaptation test; MR = medial rectus muscle; LR = lateral rectus muscle.

*Independent t-test; †chi-square test.

Table 4

Comparisons of clinical features among the three groups

jkos-60-1257-i004

Values are presented as mean ± standard deviation or number (%).

BCVA = best corrected visual acuity; logMAR = logarithm of minimal angle of resolution; APCT = alternative prism cover test; PD = prismdiopters; PAT = prism adaptation test.

*One-way analysis of variance; †,‡,§one-way analysis of variance with post-hoc; ∥chi-square test.

Notes

Conflicts of Interest The authors have no conflicts to disclose.

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