Diplopia After Cataract Surgery: Retrospective Review of Orthoptic Assessments

Theme: Cataract surgery*
What: Cataract surgery
Part of: Cataract III: Innovations and research in cataract surgery / Cataracte III: 3. Innovations et recherches en chirurgie de la cataracte
When: 6/2/2024, 11:15 AM - 12:45 PM
Where: Room | Salle 801

Abstract

Purpose: In this study, we aimed to evaluate the causes and outcomes of patients with diplopia post-cataract surgery who were referred for orthoptic assessment.

Study Design: Retrospective observational study.

Methods: We conducted a retrospective review of patients who were referred for orthoptic evaluation at two tertiary care hospitals between January 1, 2019, and November 30, 2022. Patients eligible for inclusion displayed diplopia symptoms following cataract surgery, as documented in their referral history. Exclusion criteria encompassed cases involving simultaneous cataract surgery with other ocular procedures, individuals under the age of 18, those with pre-existing diplopia, or instances where the operative reports were inaccessible. The primary objectives were to determine the etiology of diplopia in these patients and assess the proportion of individuals who received interventions. Statistical significance was defined as a p-value of <0.05. We employed a one-way analysis of variance (ANOVA) test to investigate potential differences in patient characteristics among those with different underlying causes of diplopia.

Results: In this ongoing study, data has been collected from fifty-nine patients, with a mean age at assessment of 74.3 years and a 48% female representation. All patients underwent cataract surgery under topical anesthesia. In five cases (6.8%), periocular infiltrative anesthesia was employed for vitrectomy, either preceding or following cataract surgery. A single intraoperative complication, posterior capsular rupture, occurred in one patient (1.7%). The etiologies of diplopia encompassed various conditions, including decompensated esophoria/exophoria (23.7%), decompensated fourth nerve palsy (10.2%), monocular diplopia (8.5%), convergence insufficiency (8.5%), retinal diplopia (3.4%), periocular anesthetic myotoxicity (3.4%), and sixth nerve palsy (1.7%). The remainder had hypertropia (22.0%) or a combination of hypertropia and horizontal deviation (18.9%), for which the etiology could not be obviously discerned from the report. Neuroimaging was performed in 11.9% of cases but did not reveal any explanatory pathology. Interventions to address diplopia included prisms (42.4%), strabismus surgery (10.2%), updated refractive correction (5.1%), and convergence exercises (1.7%). A neuro-ophthalmologist was involved in 22.0% of cases, and in 30.8% of these instances, the neuro-ophthalmologist also served as the cataract surgeon.

Conclusion: Many causes account for diplopia after cataract surgery. The most common intervention was prisms, followed by strabismus surgery and updated refractive correction. The majority were evaluated and treated by the referring surgeon and orthoptist, without involvement of a neuro-ophthalmologist.

Presenter(s)

Presenting Author: Mahraz Parvand

Additional Author(s):

Steven Bae, University of British Columbia

Sonia N. Yeung, University of British Columbia

Jean Y. Chuo, University of British Columbia

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