Abbreviated prism adaptation protocol integrated with alternate prism cover testing for preoperative measurement in acute acquired comitant esotropia.

PURPOSE This study evaluated an abbreviated prism adaptation protocol integrated with alternate prism cover testing (APCT) for more precise measurement of  maximum deviation anglesin acute acquired comitant esotropia (AACE).

METHODS This retrospective study analyzed 89 AACE patients who underwent unilateral medialrectus recession combined with lateral rectus resection between September 2020 and March 2023. Each patient underwent both traditional APCT and abbreviated prism adaptation protocol (APCT-abbreviated PAT) measurement preoperatively.Surgical planning was based on APCT-abbreviated PAT results, while traditional APCT measurements were recorded for comparison of the two measurement protocols. Surgical outcomes were evaluated at 3 months postoperatively, with success defined as residual deviation ≤5 prism diopters (PD) and absence of symptomatic diplopia in daily activities.

RESULTS The study population (mean age: 34.1 ± 14.9 years; mean spherical equivalent [SE]: -4.46 ± 2.53 diopters) exhibited significantly greater preoperative deviation measurements with APCT-abbreviated PAT compared to conventional APCT alone. The mean differential was 11.2 PD (95% CI: 7.7-14.7) for distance fixation and 9.6 PD (95% CI: 5.2-14.0) for near fixation (both p < .001). Surgical planning was based on the APCT-abbreviated PAT measurements. At 3-month follow-up, all subjects achieved successful surgical outcomes with alignment within 5 PD and absence of symptomatic diplopia in daily activities. Worth four-dot testing demonstrated significant improvement in binocular sensory function,with 85.4% achieving normal fusion at distance and 100% at near fixation postoperatively (p < .001). No patients exhibited suppression atpostoperative follow-up.

CONCLUSIONS An abbreviated prism adaptation protocol integrated with alternate prism cover testing facilitates quantification of maximum deviationangles in AACE. All patients achieved successful surgical outcomes at 3-monthfollow-up, supporting the clinical utility of this approach for accurate preoperative measurement and surgical planning in AACE patients.