Intractable Diplopia After Strabismus Surgery in Adults

Abstract

To investigate the incidence of persistent intractable diplopia in adults undergoing surgery for longstanding, constant strabismus and to define tests that may be useful for identifying patients at risk for developing this complication.Methods: A retrospective medical record review of adults without diplopia undergoing surgery for constant strabismus.Results: Medical records of 424 adult patients undergoing strabismus surgery were studied. Of these patients, 143 (34%) experienced diplopia when tested preoperatively with prisms to simulate the desired surgical outcome. Only 40 patients (9%) had temporary diplopia after surgery, which resolved in all cases by 6 weeks postoperatively. Three patients (0.8%) developed persistent intractable diplopia. Experiencing diplopia with preoperative prism testing was significantly more likely to result in postoperative diplopia than if diplopia was not present preoperatively (PϽ.001 and P = .04 for tem-

Incidence, risk factors and management of intractable diplopia

“…These were selected cases though and therefore does not provide a reliable indication of incidence. The only other study exploring intractable diplopia after strabismus surgery, reported an occurrence of 3 cases from 424 patient records (0.8%) 2. This is greater than our finding (0.2%, 1 in 494) but is difficult to compare given the estimate was derived from retrospective medical records of a single surgeon.…”

“…A careful preoperative examination may help to reduce the risk, though its onset can also be unpredictable 2. Though no cases of intractable diplopia were identified in this study to be directly attributable following amblyopia treatment, cases have been reported in the literature, and future management using emerging treatments to actively remove suppression may need careful patient selection to avoid the risk of inducing intractable diplopia.…”

Incidence, risk factors and management of intractable diplopia

“…These were selected cases though and therefore does not provide a reliable indication of incidence. The only other study exploring intractable diplopia after strabismus surgery, reported an occurrence of 3 cases from 424 patient records (0.8%) 2. This is greater than our finding (0.2%, 1 in 494) but is difficult to compare given the estimate was derived from retrospective medical records of a single surgeon.…”

“…A careful preoperative examination may help to reduce the risk, though its onset can also be unpredictable 2. Though no cases of intractable diplopia were identified in this study to be directly attributable following amblyopia treatment, cases have been reported in the literature, and future management using emerging treatments to actively remove suppression may need careful patient selection to avoid the risk of inducing intractable diplopia.…”

Adults with Longstanding Strabismus: Psychosocial and Functional Impacts and Reasons behind Surgery Delay

“…The current study showed that more than one-third of patients with strabismus surgery delay (35.4%) had not been offered an intervention by their health care provider who advised them that nothing could be done, adopted nonsurgical measures like prisms or patching of one eye for long period of time, or exaggerated the possible complications of surgical intervention; for example, we found that many health care providers and some ophthalmologists had exaggerated the risk of having persistent diplopia after surgical correction of longstanding strabismus pushing many patients to avoid surgery despite the small risk of developing this complication as reported by Kushner et al [ 23 ]. This was also the most frequent reason for surgery delay in the study conducted by Coats et al accounting for about 27% of the cases [ 1 ].…”

The Benefits, Risks, and Efficacy of Strabismus Surgery in Adults

“…Regardless, intractable postoperative diplopia was quite rare. In that series, 32 only three patients (0.7%) developed persistent intractable double vision after surgery. Furthermore, all three were known to be at risk for this rare complication based on preoperative prism testing, yet they elected to have surgery anyway.…”

Incidence, risk factors and management of intractable diplopia

“…These were selected cases though and therefore does not provide a reliable indication of incidence. The only other study exploring intractable diplopia after strabismus surgery, reported an occurrence of 3 cases from 424 patient records (0.8%) 2. This is greater than our finding (0.2%, 1 in 494) but is difficult to compare given the estimate was derived from retrospective medical records of a single surgeon.…”

“…A careful preoperative examination may help to reduce the risk, though its onset can also be unpredictable 2. Though no cases of intractable diplopia were identified in this study to be directly attributable following amblyopia treatment, cases have been reported in the literature, and future management using emerging treatments to actively remove suppression may need careful patient selection to avoid the risk of inducing intractable diplopia.…”

Adults with Longstanding Strabismus: Psychosocial and Functional Impacts and Reasons behind Surgery Delay

“…The current study showed that more than one-third of patients with strabismus surgery delay (35.4%) had not been offered an intervention by their health care provider who advised them that nothing could be done, adopted nonsurgical measures like prisms or patching of one eye for long period of time, or exaggerated the possible complications of surgical intervention; for example, we found that many health care providers and some ophthalmologists had exaggerated the risk of having persistent diplopia after surgical correction of longstanding strabismus pushing many patients to avoid surgery despite the small risk of developing this complication as reported by Kushner et al [ 23 ]. This was also the most frequent reason for surgery delay in the study conducted by Coats et al accounting for about 27% of the cases [ 1 ].…”

The Benefits, Risks, and Efficacy of Strabismus Surgery in Adults

“…Regardless, intractable postoperative diplopia was quite rare. In that series, 32 only three patients (0.7%) developed persistent intractable double vision after surgery. Furthermore, all three were known to be at risk for this rare complication based on preoperative prism testing, yet they elected to have surgery anyway.…”

Incidence, risk factors and management of intractable diplopia

“…These were selected cases though and therefore does not provide a reliable indication of incidence. The only other study exploring intractable diplopia after strabismus surgery, reported an occurrence of 3 cases from 424 patient records (0.8%) 2. This is greater than our finding (0.2%, 1 in 494) but is difficult to compare given the estimate was derived from retrospective medical records of a single surgeon.…”

“…A careful preoperative examination may help to reduce the risk, though its onset can also be unpredictable 2. Though no cases of intractable diplopia were identified in this study to be directly attributable following amblyopia treatment, cases have been reported in the literature, and future management using emerging treatments to actively remove suppression may need careful patient selection to avoid the risk of inducing intractable diplopia.…”

Adults with Longstanding Strabismus: Psychosocial and Functional Impacts and Reasons behind Surgery Delay

“…The current study showed that more than one-third of patients with strabismus surgery delay (35.4%) had not been offered an intervention by their health care provider who advised them that nothing could be done, adopted nonsurgical measures like prisms or patching of one eye for long period of time, or exaggerated the possible complications of surgical intervention; for example, we found that many health care providers and some ophthalmologists had exaggerated the risk of having persistent diplopia after surgical correction of longstanding strabismus pushing many patients to avoid surgery despite the small risk of developing this complication as reported by Kushner et al [ 23 ]. This was also the most frequent reason for surgery delay in the study conducted by Coats et al accounting for about 27% of the cases [ 1 ].…”

The Benefits, Risks, and Efficacy of Strabismus Surgery in Adults

“…Regardless, intractable postoperative diplopia was quite rare. In that series, 32 only three patients (0.7%) developed persistent intractable double vision after surgery. Furthermore, all three were known to be at risk for this rare complication based on preoperative prism testing, yet they elected to have surgery anyway.…”