10 Prism adaptation testing in children to improve surgical outcomes in esotropia surgery.

The aim of strabismus surgery is to improve alignment and ideally restore binocular vision. Prism adaptation (PAT) in esotropia is known to improve post-operative outcomes by allowing choice of target angle in line with pre-operative fusion potential. Reaching a successful end-point in PAT requires co-operation, which is not a given in the paediatric population. The purpose of this study is to describe the successful use of prism adaptation in children in planning target angles for esotropia surgery.Retrospective review of 29 cases from a tertiary centre was conducted, including cases who underwent PAT prior to esotropia surgery over a 6-year period (Jan 2016- Jan 2023). Data was collected from the electronic patient record including patient age, diagnosis, measurements of presenting and prism adapted angles, surgery performed and surgical outcomes.Successful prism adaptation was carried out in children of ages 3-16 . The average presenting angle of esodeviation was 20.9 PD in the distance and 27.3 PD at near. The average maximum prism adapted angle, which was the target angle used for surgery, was 35.3 PD (range 25-50PD). All patients underwent bimedial recessions except one, a re-do who underwent LR re-advancement. 3 patients had one LR resection in addition (3/28). 89.7% of patients achieved binocular vision with stereopsis, 3.4% achieved binocular vision with simultaneous perception. 2 patients had no demonstrable BV, neither were overcorrected post-operatively.Pre-operative PAT is an effective tool in pre-operative assessment of paediatric esotropia patients with binocular potential and can be used to optimise surgical planning and outcomes.