Diplopia After Refractive Surgery

Abstract

To report the occurrence of persistent diplopia manifesting after refractive surgery, to describe the different causes of this complication, to provide risk stratification for its occurrence, and to outline minimal screening techniques for its prevention. Methods: A retrospective medical record review of patients seen in 2 private strabismus practices who experienced persistent diplopia after refractive surgery. Results: A total of 28 patients were identified who met the inclusion criteria. The causes of postoperative diplopia could be traced to 1 of 5 mechanisms. These included technical problems, prior need of prisms, anisei-konia, iatrogenic monovision, and improper control of accommodation in patients with strabismus. The recommended screening techniques would have identified all patients in this series as being at risk for postoperative diplopia with the exception of those in whom technical problems were responsible. Conclusions: Diplopia can become manifest after refractive surgery. With proper attention paid to risk stratification and recommended screening criteria, the incidence of this complication can be minimized.

Sensory eye balance in surgically corrected intermittent exotropes with normal stereopsis

“…Strabismus may be associated with amblyopia if it occurs early in visual development 5 . Several therapies have been proposed for treating ocular misalignment of strabismus including refractive correction 6 , eye exercises 7 , botulinum toxin therapy 8 and surgical alignment 9 . Of these, surgery is a commonly used treatment especially for patients with a large angle of misalignment 10 .…”

The Change in Deviation Measurements for Partial Accomodative Strabismus After Refractive Surgery: Early Postoperative Evaluation

“…Refractive surgery in strabismus patients is a special subject that continues to be studied (1)(2)(3). It has been reported in the literature that strabismus and diplopia can also occur de novo after different refractive procedures performed in ametropic patients (4,5). This has led ophthalmologists to perform preoperative orthoptic examinations to identify patients at risk (6).…”

Fixation Switch Diplopia

“…Hale et al recommended that cataract surgery initially be performed on the nonamblyopic eye in cases of bilateral visually significant cataracts. Similarly, before cataract surgery, Kushner and Kowal (7) recommended a patient screening procedure consisting of history of childhood eye disease or treatment such as patching or eye muscle surgery, checking spectacles for prism, cycloplegic refraction and cover testing for all patients undergoing refractive surgery, especially for those planning for “monovision.” A 4 base-out prism test can be performed to quickly identify a monofixation syndrome in patients with postoperative diplopia, as can blurring the fixating eye. Monofixation syndrome may go undiagnosed during the course of a patient’s lifetime due to the lack of a visible strabismus angle and the mild level of amblyopia.…”