Diplopia after cataract surgery*1Comparative results after topical or regional injection anesthesia

Diplopia in adult patients following cataract extraction and refractive surgery

“…None of the patients had diplopia. In a comparative series by Yanguela et al [5] with over 3000 patients, the incidence of diplopia following retrobulbar anesthesia was 0.98%, and with topical anesthesia 0.21%. Therefore, the incidence of postoperative diplopia following cataract extraction is substantially decreased in cases with topical anesthesia compared to local anesthesia.…”

“…Most were related to surgical trauma (75%), followed by pre-existing strabismus (18%), aniseikonia or anisometropia (5%), and macular abnormality (2%) [8]. In Yanguela et al's series, the causes for diplopia were motility disturbance from retrobulbar anesthesia (46%), refractive errors with intraocular lens luxation from both retrobulbar and topical anesthesia groups (33%), and fusional loss from the retrobulbar anesthesia group (21%) [5].…”

“…Persistent diplopia following cataract extraction is uncommon. Estimates of postoperative diplopia range from 0.3 to 0.23% for vertical diplopia [2,3], and from 0.67 to 0.85% for all types of strabismus combined [4,5]. In one prospective study of 118 uneventful cataract extractions with retrobulbar anesthesia, the incidence of misalignment in the immediate postoperative period was 22% [4].…”

Change in ocular alignment after topical anesthetic cataract surgery

“…Johnson [10], in a large series, reported a rate of 0.23% after retrobulbar anesthesia, whereas no patient undergoing topical anesthesia developed diplopia. Yanguela et al [12] suggest that the use of topical anesthesia may decrease the incidence of diplopia after cataract surgery, secondary not only to muscle damage but to fusion disruption as well. However, the retrospective character of these works imposes some limitations.…”

“…Persistent binocular diplopia or misalignment is an uncommon, but disappointing, adverse outcome of uneventful local anesthetic cataract surgery [1][2][3][4][5][6][7][8][9][10][11][12]. Several different mechanisms have been proposed to account for diplopia in these cases: pre-existing disorders (e.g., thyroid eye disease), sensory deprivation by cataract (e.g., decompensated heterophorias), central disruption of binocular fusion, optical aberrations, and surgical/anesthetic trauma to the extraocular muscles or orbital soft tissue [4][5][6][7][8][9][10][11][12][13].…”