Surgical outcomes of patients with acute acquired comitant non-accommodative esotropia (AACE) with and without pre-operative prism adaptation test (PAT)

Purpose To compare the surgicaloutcomes of patients with acute acquired comitant non-accommodative esotropia(AACE) with and without pre-operative prism adaptation test (PAT).Methods The records of patientsdiagnosed with AACE who underwent strabismus surgery between January 2018 andDecember 2020 were reviewed. Those who had pre-operative PAT performed by asingle surgeon and those who had surgery without PAT by another single surgeonwere included in the analysis. The surgical outcomes were compared between thetwo groups, and postoperative alignment within 8 PD was considered a surgicalsuccess.Results Thirty-six patients were included in the study; 15 underwent a 30-minute PATpre-operatively. The mean age in the PAT and non-PAT groups was 16.6 ± 7.7 years and 12.3 ± 5.8 years, respectively, and was comparable (p = .06). The meanpre-operative esotropia (40 ± 8.5PD vs 40 ± 15.6, p = .7) and medial rectusrecession (5.31 ± 0.8 mm vs 5.45 ± 0.7 mm, p = .6) were similar in both groups (p < .05). The median postoperative follow-up duration was 8 months (IQR:9.75 months). Five of 15 (33%) were prism responders (angle of deviationincreased by 10 PD). The median change in esotropia at presentation andpost-PAT was 4.5 PD (IQR: 12.5 PD). Overall surgical success was similarbetween the groups (80% vs 81%; p = .9). Only one patient in the non-PAT groupexperienced postoperative diplopia.Conclusion Surgical outcomes werecomparable, irrespective of the prism adaptation test. The prism adaptationtest did not reveal consistently higher target angles; hence, for comparabledeviation, the medial rectus recession and surgical outcomes did not differ, irrespective of whether PAT was performed pre-operatively.