A randomized comparison of prism adaptation and augmented surgery in the surgical management of esotropia associated with hypermetropia: one-year surgical outcomes.
OBJECTIVE: To compare motor and sensory 1-year surgical outcomes in patients with hypermetropic esotropia, managed with either augmented surgery based on the average of the near deviation with and without correction or preoperative prism adaptation. METHODS: Forty-three patients with hypermetropic esotropia without distance-near disparity entered a randomized prospective evaluation of augmented surgery (group A, 27 patients) versus prism adaptation (group P, 16 patients). The formula for augmenting the amount of the rectus muscle recession was based on the average of the near deviation with and without correction in group A and the prism-adapted angle of deviation in group P. During prism adaptation, 9 of 16 patients in group P responded to prism. Motor and sensory outcomes of the Worth 4-dot test at 6 and 0.33 m and the Titmus stereotest were evaluated 1, 3, 6, and 12 months after surgery. RESULTS: Postoperative deviations of 8 PD or less at distance were achieved in 24 of 27 patients (89%) of group A and in 7 of the remaining 8 patients (88%) of prism responders and in all 7 prism nonresponders (100%) in group P. No significant difference existed between groups A and P, as well as between the prism responders and prism nonresponders in group P in terms of near and distance deviation 1 year after surgery. The sensory outcomes improved over time in group A and prism responders. CONCLUSION: There were no significant differences in the surgical outcomes between each group. However, the small sample size may limit the power to detect any statistically significant differences.