Nonoperative treatment of diplopia after IOL implantation

PURPOSE: Analysis of effects of non-operative treatment of diplopia complicating cataract surgery with IOL implantation or secondary IOL implantation. MATERIAL AND METHODS: 22 patients with diplopia occurring after cataract surgery with IOL implantation or secondary IOL implantation were enrolled into the study. Only the patients who were not eligible for surgery or declined surgical treatment, were included. Each patient had complete ophthalmic and orthoptic examination with Hess-screen-test and prism alternate cover tests. Predicting factors of persistent diplopia were determined. RESULTS: The therapy consisted of prism correction in 77.3% of patients and prism with botulin toxin injections in 9.1% of patients. In two persons diplopia persisted due to cyclotrophia and decentration of IOL, and these patients were eventually treated surgically. The treatment was succesful in 72.7% of patients in whom single vision was achieved. In 18.2% of patients occasional diplopia was found and in 9.1% the therapy was not effective. Disorders precipitated by prolonged cataract--related occlusion and uncorrected aphakia, disorders resulting from surgical trauma to extraocular muscles (retrobulbar or peribulbar anesthesia) and preexisting complications of ocular alignment, all predict related persistent diplopia after IOL implantation. CONCLUSIONS: (1) Cataract surgery with IOL and secondary IOL implantation should be performed before the loss of binocular function. (2) Retrobulbar and peribulbar anesthesia may cause surgical muscular trauma, therefore topical anesthesia is recomended. (3) Prism correction (with or without botulin toxin injection) is an effective therapy.