Prolonged preoperative prismatic treatment in alternating convergent squint

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology
• Strabismus Surgery

Background:

• Alternating convergent squint (esotropia) is a common condition in children.
• Surgical correction is often necessary but outcomes can vary.
• Preoperative management strategies aim to optimize surgical success.

Purpose of the Study:

• To evaluate the efficacy of prolonged preoperative prismatic correction in children with alternating convergent squint.
• To compare surgical and sensory outcomes between prism-treated and conventional treatment groups.
• To identify factors influencing motorial outcomes in squint surgery.

Main Methods:

• A 10-year retrospective study of 178 children under 10 years old operated for alternating convergent squint.
• Inclusion criteria: no amblyopia, squint angle < 45 prism diopters (pdpt).
• Group 1 (100 children): received 6-15 months of preoperative prismatic correction. Group 2 (78 children): treated with glasses and occlusion.

Main Results:

• The prism-treated group showed significantly better eye alignment (p = 0.0001) with 7-8 pdpt motorial gain 6 months post-surgery.
• Significantly improved sensory outcomes (p = 0.0001), including stable normal retinal correspondence (NRC) or harmonious anomalous retinal correspondence (ARC), and enhanced binocularity.
• Pre-existing retinal correspondence influenced motorial outcomes (p < 0.05).
• Fewer reoperations were needed in the prism-treated group (p = 0.001).

Conclusions:

• Prolonged prismatic correction is an effective preoperative treatment for alternating convergent squint in children.
• This approach enhances both motor and sensory outcomes, leading to better binocular vision.
• Preoperative prism therapy can reduce the need for subsequent surgical interventions.