Persistent binocular diplopia following cataract surgery: Aetiology and management

Abstract

We studied all patients referred to the orthoptic department with binocular diplopia following cataract surgery between January 1991 and June 1993. Persistence of diplopia for a minimum of 3 months after cataract surgery was required for inclusion in the study. Eighty-one patients (2% of all patients who underwent cataract surgery during this time) satisfied the entry criteria. The patients fell into two groups: non-traumatic and traumatic cataracts. Horizontal deviations were seen in 24 patients. Vertical deviations were seen in 8 patients and a combined horizontal and vertical deviation was seen in 49 patients. Fresnel prisms were used to manage the diplopia in 58 patients. Of these, 48 patients in the non-traumatic group regained binocular single vision with this prism while 10 in the traumatic group benefited. Mechanical and sensory causes are discussed.

Diplopía postcirugía de catarata con anestesia subtenoniana

“…However, two patients had a small a vertical deviation (< 8 diopters) and in another one (who rejected muscle surgery) the deviation is of 12 diopters. Some authors published good results only with prismatic treatment, but don't have any case of restrictive strabismus and the deviations are small (10). In general, a large percentage of cases (which is variable indifference publications) will require surgery (1,2,5,6,8,(13)(14)(15).…”

“…The mean time since the appearance of diplopia up to our first treatment was of 5 months, SD: 5.45 (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Table II shows data referring to the treatments and their results.…”

Strabismus in Senile Cataract Patients

“…14 Actually, a small number of reports described the association between senile cataract and strabismus. [1][2][3][4][5][6] Most of these studies described the relation between senile cataract and strabismus only after cataract surgery. It is difficult to evaluate the association of cataract and strabismus after cataract surgery because strabismus can develop as a result of surgery itself or the administration of local anesthesia.…”

“…Some reports have evaluated the association of strabismus with senile cataract [1][2][3][4][5][6] ; however, only 2 of these reports have examined this association before cataract surgery, 1,2 ie, the occurrence of strabismus among patients with senile cataract has been reported mainly in regard to aphakia. In another report, 7 among 106 strabismus patients older than the age of 60 years, only 1 patient was reported to suffer from senile cataract whereas 6 other patients developed strabismus only after cataract surgery.…”

Complications Associated with Cataract Surgery

“…Some cases are due to vertical or less commonly horizontal muscle imbalance which is thought to be due to direct surgical trauma or due to an anaesthetic myotoxic effect (71). Patients with preoperative diplopia should also be counselled about this risk as the deviation may be unstable in a quite large proportion of these patients and some cases may need surgical treatment to correct their diplopia (72). Another cause of postoperative diplopia is aniseikonia due to surgically induced anisometropia.…”