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Long-term outcome of prismatic correction in children with consecutive esotropia after bilateral lateral rectus
Eun Kyoung Lee1, Hee Kyung Yang2, Jeong-Min Hwang2
1Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
Insights
Prism glasses effectively treat consecutive esotropia in children after eye muscle surgery. Most children were weaned off prisms within three years, showing good visual outcomes.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Surgery
Background:
- Consecutive esotropia can develop after bilateral lateral rectus (BLR) recession for exotropia in children.
- Prismatic correction is a potential non-surgical management option for this condition.
Purpose of the Study:
- To evaluate the long-term efficacy of base-out prismatic correction in children with consecutive esotropia following BLR recession.
- To assess motor alignment, sensory status (stereopsis), and the rate of prism weaning.
Main Methods:
- Retrospective analysis of 39 children treated with base-out prism glasses for consecutive esotropia after BLR recession.
- Evaluation of clinical characteristics, duration of prism treatment, rate of esodeviation angle decrease, and changes in stereopsis.
Main Results:
- A successful motor outcome was achieved in 66.7% of patients.
- Stereoacuity improved or was maintained in 79.2% of patients; no loss of stereopsis occurred.
- 82.1% of patients were weaned off prisms within a mean follow-up of 37 months.
Conclusions:
- Prismatic correction provides a favorable motor outcome for consecutive esotropia post-BLR recession.
- It effectively reduces esodeviation and maintains or improves stereopsis in most pediatric patients.
- A significant majority of children can be successfully weaned off prism glasses.
Aims:
To determine the long-term outcome of prismatic correction in consecutive esotropia after bilateral lateral rectus (BLR) recession in children.
Methods:
Of 392 children with exotropia who received BLR recession, 44 developed consecutive esotropia. Five children underwent reoperation and 39 were treated with base-out prism glasses. The clinical characteristics and the efficacy of prismatic correction defined as the duration of prism treatment and the annual rate of decline in esodeviation angle (prism dioptres (PD)/year) after prismatic correction, clinical success rates based on postoperative alignment at distance, and the change in stereopsis were evaluated in the children who were treated with base-out prism glasses.
Results:
After a mean follow-up duration of 37.0±11.5 months, a successful motor outcome was achieved in 66.7% of patients and stereoacuity was improved or maintained in 79.2%. No patient lost stereopsis as a result of overcorrection. Prism glasses were prescribed an average of 7.4±8.1 months after surgery. During prism wear, the annual rate of decline in esodeviation was 4.2±6.7 PD. The mean duration of prism wear was 24.0±10.5 months and 82.1% were weaned off prisms at the last follow-up examination.
Conclusions:
In patients with consecutive esotropia after BLR recession, the angle of esodeviation continuously decreased and 82% were weaned off prism glasses after 3 years. Prismatic correction achieves good motor outcome while maintaining a favourable sensory status in most patients with consecutive esotropia after BLR recession.
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