Surgical outcomes for acute acquired comitant esotropia with vs without prism adaptation testing
Reviewed by Fiona Rowe

The aim of this study was to assess the efficacy of preoperative prism adaptation test (PAT) in cases of acute acquired comitant esotropia (AACE) in an Indian population. This was a prospective study of 40 patients. 20 patients had 1 hour of PAT (PAT group) and 20 patients had no PAT (control group). Mean age was 14.60 ±6.32 years for PAT (55% male) and 13.30 ±4.27 years for controls (50% male). Baseline angle of deviation for distance and near was 22.30 ±3.89PD and 24.05 ±4.54PD (PAT), and 22.2 ±3.98PD and 23.9 ±4.42PD (controls) respectively. There was a significant increase in angle for the PAT group after 1-hour occlusion (36.90 ±3.84PD). The surgical target angles were significantly different between groups. Postoperatively at 12 weeks follow-up, angle of deviation for distance and near was 1.70 ±1.42PD and 2.55 ±1.82PD (PAT), and 4.75 ±3.39PD and 6.95 ±3.35PD (controls) respectively (significant differences). Achievement of primary motor success was 100% for PAT vs 80% for controls. The authors conclude PAT revealed the maximum angle of deviation and thereby reduced risk of under-correction and need for reoperation, with better surgical outcomes. Strengths of this study were its prospective and randomised design with consistent measurements and surgery by one surgeon. Limitations are inclusion of cases <30PD, limited follow-up and single centre.

Comparative evaluation of surgical outcomes in acute acquired comitant esotropia managed with and without preoperative prism adaptation test.
Verma P, Khurana M, Tamar V, et al.
STRABISMUS 
2025;33(4):267–72.