Application of fresnel prism in patients with different types of binocular diplopia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To discuss the efficacy of fresnel prism in different types of binocular diplopia patients.<p>METHODS: This retrospective study reviewed 20 patients who received fresnel prism treatment between June 2018 and November 2020 in Jiangmen Central Hospital. Eight of them were diagnosed as acute acquired comitant esotropia, five patients were thyroid-associated ophthalmopathy, and seven patients were eye misalignment caused by cranial nerve palsies. The outcome measures were deviation, near stereoacuity, asthenopia and driving ability at pre-treatment and post-treatment.<p>RESULTS: The deviations were decreased after treatment. There were significant differences between pre-treatment and post-treatment(<i>P</i><0.05). The patients with acute acquired comitant esotropia or eye misalignment caused by cranial nerve palsies recovered near stereoacuity meanwhile significant difference between before and after treatment(<i>P</i><0.05). There were no significant differences between before and after treatment in patients with thyroid-associated ophthalmopathy(<i>P</i>>0.05). Thirteen patients recovered in the driving ability while fifteen patients were cured of asthenopia. There were significant differences between before and after treatment(all <i>P</i><0.05).<p>CONCLUSION: Fresnel prism treatment could decrease deviations in binocular diplopia patients, improved near stereoacuity and quality of life.

Clinical Characteristics and Outcomes of Smartphone Overusers with Acute Acquired Comitant Esotropia

PURPOSE: To evaluate the clinical features and treatment outcomes of smartphone overusers with acute acquired comitant esotropia. METHODS: We retrospectively reviewed the medical records of patients ≥ 15 years of age who used a smartphone for > 4 hours a day for > 1 year, and who were diagnosed with acute acquired comitant esotropia from May 2011 to January 2016. We analyzed sex, age at the time of manifestation and duration of esotropia, refractive error, deviated angle at the first and final visits, and the results of refraining from smartphone use, use of the Fresnel prism, and surgery for esotropia. RESULTS: A total of 13 patients were studied, including 8 males and 5 females. The mean age at development of esotropia was 22.7 ± 9.7 years. The mean duration of esotropia before the first visit was 28.0 ± 33.0 months, and the mean follow-up period was 16.4 ± 16.4 months. The mean angle of esotropia was 21.8 ± 7.0 prism diopters (PD) at distance and 22.2 ± 7.9 PD at near. There were eight myopic patients; the other patients were emmetropia. The esotropia of all patients did not improve after refraining from smartphone use. There was no improvement in five patients who were wearing the Fresnel prism for ≥ 4 months. A total of six patients were treated with bilateral medial rectus recession; only one patient remained orthotropic at postoperative 6 months, three patients were undercorrected, and two had a recurrence. CONCLUSIONS: Esotropia persisted after refraining from smartphone use or wearing a Fresnel prism in acute acquired comitant esotropia patients who were smartphone overusers, and the surgical prognosis of these patients was relatively poor.

Strabismus Following Scleral Buckling Surgery.

Purpose: The purpose was to assess the incidence of strabismus, relationship of strabismus with type, and width of the scleral buckle (SB) after SB surgery for retinal detachment. Methods: Retrospective analysis of 360 eyes of 344 patients, treated for rhegmatogenous retinal detachment with SB surgery between January 2008 and January 2013 was done. Results: The mean age of patients was 38.45 ± 18.12 years (range: 7-89 years) was detected in 48 out of 344 (13.95%) patients at 6 weeks after SB surgery. Horizontal deviation was the most common type. Incidence of strabismus was higher after repeat SB surgery (4/9, 44.4%) compared to patients who had single SB surgery (44/335, 13.1%) (P = 0.02). Strabismus was observed in 18.5% of patients with implants, compared to 11.3% of patients who received explants (P = 0.02). Strabismus surgery was performed on 2 (4.1%) cases. Conclusion: Horizontal strabismus is common after SB surgery for repair of retinal detachment. Repeat scleral buckling and use of implants resulted in a higher incidence of strabismus in the post-operative period. Majority of these cases resolve with conservative management.

The Prismatic Effect on Stereoacuity in Intermittent Exotropia

PURPOSE: To evaluate the effect of acrylic refractive prism and Fresnel membrane prism on stereoacuity in intermittent exotropia. MATERIALS AND METHODS: Stereoacuities of fifty-two patients (mean age, 12.4 years; range 6 to 45 years) with intermittent exotropia were measured using the Titmus and TNO stereotests, while they wore prisms of varying power on nonfixating eye or evenly on each eye. RESULTS: Stereoacuities were significantly reduced with increasing prism power for both prisms, ranging from 8 to 25 prism dipotres. The effects on stereoacuity in single acrylic prism and single Fresnel prism were similar, whereas spilt Fresnel prisms reduced stereoacuity more than spilt acrylic prisms. Spilt prisms were found to have much less effect on stereoacuity than single prisms for both acrylic and Fresnel prisms. CONCLUSION: The use of acrylic refractive prism shared evenly on each eye would be optimal method to minimize the reduction of stereoacuity during the prismatic therapy for intermittent exotropia.

Clinical Course of Patients With Delayed Consecutive Esotropia After Exotropia Surgery

PURPOSE: To report the characteristics and therapeutic results of patients with delayed consecutive esotropia after undergoing surgery for exotropia. METHODS: Ten patients with delayed consecutive esotropia of more than 10 prism diopters (PD) after orthotropia was obtained postoperatively were included in this study. The authors investigated the clinical characteristics, the deviated angle at postoperative day one, the duration between surgery and orthotropia, the duration between surgery and delayed esotropia, the angle of esotropia, and the result of treatment in delayed consecutive esotropia. RESULTS: The average of the preoperative angle of exodeviation was 30PD at distance and 31PD at near. The patients underwent surgery for exotropia at a mean age of 5.3 years, and one day postoperatively, the angle of esodeviation was 12PD at distance and 10PD at near. All 10 patients demonstrated orthotropia at 0.9 months after surgery. However, esotropia of 21PD occurred 4 months after surgery for all patients. Six of the 10 patients demonstrated orthotropia or 10PD or less at the last visit after patching therapy or fitting for Fresnel prism glasses. The remaining four patients did not improve or showed aggravated esotropia with a doubled-angle of esotropia. CONCLUSIONS: In patients with orthotropia after exotropia surgery, delayed consecutive esotropia can occur, and the prognosis of non-surgical treatment is relatively poor.

The Effect of Fresnel Prism Treatment in Consecutive Esotropia

PURPOSES: To investigate the effect of Fresnel prism treatment in patients with consecutive esotropia after the surgery of exotropia. METHODS: Eighteen patients who have failed alternating occlusion therapy at least 1 month for consecutive esotropia without limitation of ocular motility following surgery for an exotropia were managed with Fresnel prism for esotropia associated with diplopia. The Fresnel prismatic power was selected to solve the diplopia and was changed in accordance with the degree of esodeviation during the follow up period. The surgical correction was performed in the case with increase of esodeviation in spite of the Fresnel prism therapy for 6 months or more. The angle of deviation and diplopia before and after the Fresnel prism therapy were investigated. RESULTS: The mean age at surgery for an exotropia was 7.8 years. The Fresnel prism therapy was performed at 4.2 months after exotropia surgery to solve esotropia in average 15.4 prism diopters (PD) at distance and 14.8PD at near. Of the 18 patients 11 (61.1%) had a successful outcome after average 14.8 months, i.e. 8PD or less of esodeviation, with relief of diplopia without the Fresnel prism. Two patients used the Fresnel prism to solve diplopia associated with esodeviation of 8PD or less. Five patients had esodeviation with 10PD or more and 2 of them were eventually needed a operation for esotropia. CONCLUSIONS: The Fresnel prism treatment is an effective device in treating diplopia as well as decreasing the frequency of surgery for esotropia in consecutive esotropia with diplopia.

Fresnel prism in Paralytic strabismus

We performed clinical evaluations on 26 patients who were prescribed glasses with full correction and Fresnel prism for correction of abnormal head posture and/or diplopia due to incomitiant paralytic strabismus. There were 12 cases(46.2%) of superior oblique muscle palsy and 8 cases(30.8%) of lateral rectus palsy in order. Trauma was the most common cause, but non-traumatic cases were mostly caused by vascular disease of diabetes mellitus and/or hypertension. Abnormal head posture with diplopia and/or dissociated diplopia may be one of the causes of less satisfaction level than interval of prescription of Fresnel prism. Decreased visual acutiy happened when prescribed above ten prism prescription on one eye, and patients accepted with more ease when prescription wasdivided on both eyes, in spite of low prism power. We concluded that it is necessary to explain dimness due to decreased visual acuity when above ten prism power prescription is given on one eye even though prism was more effective method for diplopia gteatment.