Management of patients with small-angle esotropia and subnormal stereopsis using Fresnel prism,Graefe's Archive for Clinical and Experimental Ophthalmology

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Management of patients with small-angle esotropia and subnormal stereopsis using Fresnel prism
Graefe's Archive for Clinical and Experimental Ophthalmology ( IF 2.4 ) Pub Date : 2021-08-18 , DOI: 10.1007/s00417-021-05338-2
Haeng-Jin Lee _{1,

2} , Seong-Joon Kim _{3,

4}

Affiliation

Purpose

Monofixation syndrome (MFS) is a specific subnormal binocular vision status, either with or without a small deviation. Patients with MFS have a tendency to maintain stable ocular alignment. Correction of refractive errors and occlusion are considered as treatment option for amblyopia, and the status of MFS could be changed with long-term follow-up. The purpose of this study is to evaluate whether a Fresnel prism affected the visual acuity, angle of deviation, and sensory status in small-angle esotropia with subnormal stereopsis presenting with MFS features.

Methods

Patients with small-angle esotropia within 8 prism diopters (PD) on the simultaneous prism and cover test from 2010 to 2019 were reviewed. Patients with subnormal stereopsis defined as more than 100 s of arc (arcsec) and with the central suppression with peripheral fusion were only included. A Fresnel prism was applied to the dominant eye, and the minimum follow-up period after Fresnel prism treatment was 24 months. We assessed patient clinical characteristics, course and response to therapy including visual acuity, angle of deviation, and stereopsis.

Results

Twenty patients with a mean age of 5.5 ± 1.4 years were included. The mean duration of Fresnel prism treatment was 15.3 ± 10.3 months. After 50.7 ± 17.2 months of follow-up, VA of the non-dominant eye was changed from 0.26 ± 0.20 logMAR to 0.07 ± 0.17 logMAR (P < .001). The initial stereoacuities were 3.54 ± 0.27 log arcsec, ranged from 6000 to 400 arcsec. After the treatment with Fresnel prism, the final stereoacuities were 3.09 ± 0.58 log arcsec, ranged from 6000 to 100 arcsec (P = .001); nine patients (45%) improved stereoacuity more than two octaves. No changes in the angle of deviation or a change of fixation were observed.

Conclusions

After use of Fresnel prism, there was some improvement in visual acuity and stereopsis in patients with MFS features. Following occlusion and refractive correction, management using Fresnel prism could be attempted in small-angle esotropic patients with amblyopia or subnormal stereopsis.

中文翻译：

使用菲涅耳棱镜治疗小角度内斜视和立体视觉不正常的患者

目的

单眼固定综合征 (MFS) 是一种特定的低于正常双眼视力状态，有或没有小偏差。MFS 患者倾向于保持稳定的眼球排列。屈光不正和咬合矫正被认为是弱视的治疗选择，MFS的状态可能会随着长期随访而改变。本研究的目的是评估菲涅耳棱镜是否影响具有 MFS 特征的小角内斜视的视力、偏角和感觉状态。

方法

回顾了2010年至2019年同时进行棱镜和遮盖试验的8棱镜屈光度（PD）以内的小角度内斜视患者。仅包括定义为大于 100 s 弧 (arcsec) 和具有周围融合的中央抑制的立体视觉亚正常的患者。将菲涅尔棱镜应用于优势眼，菲涅尔棱镜治疗后的最短随访期为24个月。我们评估了患者的临床特征、病程和对治疗的反应，包括视力、偏离角度和立体视觉。

结果

包括 20 名平均年龄为 5.5 ± 1.4 岁的患者。菲涅耳棱镜治疗的平均持续时间为 15.3 ± 10.3 个月。经过 50.7 ± 17.2 个月的随访，非优势眼的 VA 从 0.26 ± 0.20 logMAR 变为 0.07 ± 0.17 logMAR ( P < .001)。初始立体视度为 3.54 ± 0.27 log arcsec，范围从 6000 到 400 arcsec。经菲涅耳棱镜处理后，最终立体视度为 3.09 ± 0.58 log arcsec，范围为 6000 至 100 arcsec（P = .001）；9 名患者 (45%) 的立体视度提高了两个八度以上。没有观察到偏离角度的变化或固定的变化。