Diplopía postcirugía de catarata con anestesia subtenoniana

Abstract

Purpose: To study the clinical signs, treatment and prognosis of strabismus after sub-Tenon's anesthesia for cataract surgery. Methods: Eight patients without previous strabismus developed incommitant diplopia immediately after cataract surgery; the left eye was affected in five patients and the right eye in three. Restrictive strabismus was diagnosed with the cover test, prisms, and active and passive ductions in all cases. In seven cases the deviation was vertical and in one patient it was horizontal. The average deviation was 17.5 S.D. 9.84 (range 5-35) prismatic dioptres in primary position. The deviation increased looking upward in seven cases, and looking sideways to the left in the other. It was considered to be a good result if the diplopia disappeared after treatment. Results: Botulinum toxin was the first treatment applied in four patients, but only one showed a good response and required no further therapy. Strabismus surgery was required in four cases, and prisms were adapted in three. Three patients required two strabismus operations. A good result was achieved in all cases, with the average time interval being 10.12 (SD 5.5) months. ORIGINAL ARTICLE RESUMENObjetivo: Estudiar las características del estrabismo secundario a la cirugía de catarata con anestesia subtenoniana; su tratamiento y pronóstico. Método: Ocho enfermos sin estrabismo previo presentaron diplopía inmediatamente después de la cirugía de catarata; cinco de ojo izquierdo, tres de ojo derecho. La exploración con cover test, prismas y ducción activa y pasiva mostró estrabismo restrictivo: siete de componente vertical y uno horizontal. La desviación media fue de 17,5 DE: 9,84 dioptrías prismáticas (rango 5-35) en la mirada al frente. La posición máxima de desviación fue en supraversión en siete, y en levoversión en otro. Todos tenían diplopía invalidante. Se considera buen resultado si desaparecía la diplopía con el tratamiento. Resultados: Cuatro casos recibieron tratamiento quirúrgico, en uno sólo se inyectó toxina botulínica y en tres se pusieron prismas. La toxina botulínica se empleó como primera opción en cuatro casos y sólo fue eficaz en un enfermo. De los cuatro casos operados, tres necesitaron dos cirugías y un paciente sólo un tiempo quirúrgico. Se consiguió buen resultado en los ocho pacientes tratados. El tiempo medio de evolución fue de 10,12 DE: 5,46 meses. 142ARCH SOC ESP OFTALMOL 2006; 81: 141-146 MERINO P, et al.

Botulinum toxin for treatment of restrictive strabismus

“…The sub-Tenon anesthesia used in cataract surgery is responsible for diplopia and restrictive strabismus secondary to muscle contracture, fibrosis, and palsy. Botulinum toxin is effective in only 25% of cases of muscle palsy, before development of muscular fibrosis, which is frequent and has an early onset in older patients 7 . In our study, outcome was successful in 40% (2/5) of cases secondary to retinal surgery, in which botulinum toxin was injected early (1–4 months after onset of symptoms).…”

“…The effect of botulinum toxin is independent of the initial deviation 6 . Other types of restrictive strabismus secondary to retinal detachment surgery, cataract surgery, and strabismus surgery have been treated with botulinum toxin, with variable results 7, 8, 9, 10…”

Sub-Tenon's anesthesia: an update

“…However, there are a small number of isolated cases of long standing strabismus, usually involving the inferior rectus. Splerer and Schwalb have reported a superior oblique palsy that resolved after one month,40 while Merino et al reported eight cases of extraocular muscle dysfunction lasting more than 6 months, four of which required strabismus surgery 41. It is to be noted that all cases received an STB using 5% lignocaine, which is concentrated enough to cause direct myotoxicity.…”

Diplopia as the Complication of Cataract Surgery

“…Sometimes orthoptic exercises help, for example, in convergence insufficiency or temporary disruption of fusion. The other less invasive procedures are injections with botulin toxin into hyperactive muscle [ 22 ]. Surgical treatment of postcataract diplopia is applied as the second choice, when the deviation is stable.…”