ROC-based validation of an 8-prism diopter surgical target angle in comitant esotropia

PURPOSE: This study aimed to identify the optimal postoperative ocular alignment that promotes the development of simultaneous perception - the most basic level of binocular vision - in children undergoing surgery for comitant esotropia. The research question focused on whether receiver operating characteristic (ROC) analysis could objectively determine the ideal alignment threshold to support binocular cooperation. METHODS: A retrospective analysis was conducted on the medical records of pediatric patients diagnosed with childhood comitant esotropia. Among these, a subset underwent strabismus surgery. Postoperative outcomes were evaluated using ROC curve analysis to determine the alignment range most predictive of achieving simultaneous perception. RESULTS: Of the 99 patients reviewed, 87 underwent surgical correction. ROC analysis revealed that achieving a postoperative alignment within 8 prism diopters (PD) was strongly associated with the development of simultaneous perception. Specifically, alignment within this range yielded a sensitivity of 90% and a specificity of 87%, confirming its predictive value for binocular function recovery. CONCLUSION: Postoperative alignment within 8 PD represents a critical target for promoting simultaneous perception in pediatric patients treated surgically for comitant esotropia. ROC analysis proved to be a valuable tool for objectively defining surgical success in restoring foundational binocular cooperation.