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L.B. Passos, I. Debert, P.G. Saraiva, M. Polati; Persistemt Diplopia after Cataract Surgery under Local Anesthesia . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2469.
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Retrobulbar local anesthesia is the commonest form used in cataract surgery performed in outpatient surgery centers. Complications described for this type of anesthesia include: ocular perforation, optic nerve lesion, retinal vascular occlusion, among others. Diplopia is an infrequent complication, and several factors may contribute to its occurrence: prolonged sensorial deprivation with disruption of fusion, surgical or anesthetic trauma to one or more extraocular muscles, preexisting deviation masked by cataract, disorders related to aphakia/pseudophakia and optical aberrations.
The objective of this study is to report the clinical characteristics and proposed treatments for persistent diplopia after cataract surgery at the Ophthalmology Clinic of the "Hospital das Clínicas" of the University of São Paulo School of Medicine, during the period between November 1999 and February 2005.
Retrospective study of the period between November 1999 and February 2005. During this interval 20453 cataract surgeries were performed using phakoemulsification and extracapsular extraction techniques at the outpatient surgery center of the "Hospital das Clínicas" of the University of São Paulo. Visual acuity, deviation as measured by prism cover test (for near and far) or Krimsky test (when visual acuity was less than 20/200), binocular rotations, versions and ductions, presence of alphabet patterns and torticollis were evaluated. Sensorial evaluation using prism and red filter was also performed.
Persistent diplopia after cataract surgery occurred in 19 patients (0.093% of the operated cases). Found types of deviation were: exotropia (n=3), esotropia (n=5), hypertropia (n=1), exotropia + hypertropia (n=5) and esotropia + hypertropia (n=5). Regarding binocular rotations, 6 patients presented dysfunction of the medial rectus (MR) muscle, 14 of the lateral rectus (LR), 10 of the superior oblique (SO), 10 of the inferior oblique (IO) and 2 patients of the superior rectus (SR). Only 2 patients had a "V" alphabetic variation and 6 patients presented torticollis, which varied according to the type of deviation.
We observed that of the 19 patients, 8 needed surgery and 4 the use of prism to alleviate the complaint. We stress the importance of adequate preoperative evaluation of extrinsic ocular motility, calling the attention of the patient to the possibility of persistent postoperative diplopia and the possible need for surgical intervention and/or prism to treat the symptom.
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