Diplopia after cataract surgery.
This article discusses clinical findings, differential diagnoses, management, and prognoses for patients with persistent diplopia after cataract extraction.
Cataract Extraction↗
Biomedical subjects
H Capó
Publications and source records attributed to H Capó.
Outcome of surgical management of superior oblique palsy: a study of 123 cases.
PURPOSE: To determine the outcome of the surgical management of superior oblique palsy at our institution. SUBJECTS AND METHODS: Retrospective review of 123 patients who underwent surgical correction of superior oblique paresis at Bascom Palmer Eye Institute from 1976 to 1996. Subject-Patients: 67% were male and 33% female. The mean age at surgery was 30.5 years (range, 2-78 years). Etiologies of the pareses were trauma (34%), congenital (33%), and acquired/non-traumatic (33%). The mean angle of preoperative vertical deviation in primary gaze was 14.0 delta (range, 0-45 delta). SURGERY: 109/123 (89%) patients underwent single muscle surgery. Of these 109, 57 had single oblique muscle surgery: a superior oblique tuck in 34/57 (60%); an inferior oblique weakening procedure in 22/57 (38%); and a Harada-Ito procedure in 1/57 (2%). The other 14 patients (11%) had bilateral surgery. RESULTS: The final postoperative vertical deviation in primary gaze was < or =3 PD in 60% of patients and < or =7 PD in 80%. The mean change in primary position vertical deviation postoperatively was 10.4 PD for distance and 13.0 PD for near. An "excellent" outcome (final vertical deviation &le3 PD in primary and reading gazes) was achieved most frequently in those patients with congenital pareses and isolated oblique muscle surgery. COMPLICATIONS: Clinically significant Brown's Syndrome occurred in 43/72 (60%) of those cases who had undergone a superior oblique tuck. The incidence of Brown's Syndrome was unrelated to tuck size. Reoperation was three times more likely to be necessary in traumatic cases than in congenital cases (35.0% vs 11.9%, p=0.02). CONCLUSIONS: Based on these results we recommend oblique muscle surgery as the initial procedure to correct superior oblique palsy when appropriate.
Adolescent↗
Vertical strabismus after cataract surgery.
PURPOSE: To compare anesthesia methods with resultant strabismus patterns in patients with vertical diplopia after cataract surgery. METHODS: The authors analyzed 28 consecutive patients with acquired vertical diplopia after cataract surgery to identify the strabismus pattern. The method of anesthesia administration was available in 21 patients. Three orbital dissections with simulated retrobulbar blocks were performed on cadavers to ascertain the possibility of injuring the vertical rectus muscles at the time of injection. RESULTS: Fifty percent of the involved muscles were overactive, 39 percent were restricted, and 11 percent were paretic. Eleven patients received retrobulbar, and ten received peribulbar anesthesia. The inferior rectus in 17 patients and the superior rectus muscle in 11 were involved. The odds of damaging the inferior rectus, as opposed to the superior rectus muscle, with peribulbar anesthesia was 4.8 times higher than with retrobulbar blocks. Cadaveric dissections showed the likelihood of direct needle injury to either vertical recti with retrobulbar blocks. CONCLUSIONS: In this patient population, permanent vertical strabismus after cataract surgery results more often from overacting or restricted muscles than from primary muscle paresis. Both the superior and inferior recti can be injured with retrobulbar anesthesia, but peribulbar injections affect the inferior rectus muscle more frequently.
Anesthesia, Local↗
Ipsilateral hypertropia after cataract surgery.
BACKGROUND: Reports of acquired strabismus caused by injection of local anesthetics during cataract surgery have increased recently. The authors proposed a mechanism to explain the occurrence of strabismus with apparent overactive muscles after cataract surgery. METHODS: The authors studied 19 patients in whom strabismus developed after cataract surgery. Prism and cover test in the diagnostic positions of gaze and forced-duction testing were used to identify the affected muscles. RESULTS: The deviation was greater in the field of action of the presumed tight muscle in 16 of 19 patients. An ipsilateral hypertropia with superior rectus muscle overaction subsequently developed in two patients with an initial hypotropia. An overaction of the ipsilateral lateral rectus muscle causing an exotropia developed in one patient with initially limited abduction. CONCLUSIONS: Myotoxicity from direct injection of local anesthetics into an extraocular muscle probably causes transient paresis followed by segmental contracture of the involved muscle. Mild contractures result in strabismus with a motility pattern of an overactive muscle. Larger amounts of contracture lead to restrictive strabismus. The risk of strabismus may be decreased by administering the local anesthetic into sub-Tenon space using a blunt-tipped cannula when performing cataract surgery.
Adult↗
High myopia following excessive occlusion therapy in the first year of life.
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Amblyopia↗
Clinical and echographic findings in idiopathic orbital myositis.
We performed a retrospective chart review of 100 patients with idiopathic orbital myositis, who were of ages 9 to 84 years. Data from 75 patients gave the following results. Females were affected more than twice as often as males. Fifty-one patients (68%) had single muscle involvement, with the lateral and medial recti affected most frequently (38 cases [33%] and 33 cases [29%] of muscles, respectively). In 34 patients (45%), affected muscles functioned normally; the remaining 55% (63 muscles) were fairly equally distributed between paretic (20%), restrictive (20%), or combined paretic and restrictive (15%) myopathies. Analysis of muscle function, echographic findings, and duration of symptoms indicates that within days of onset of symptoms, the affected muscle is initially enlarged but retains normal function. Within the first two weeks, continued enlargement results in muscle paresis. The muscle may then enter a partially or completely restrictive phase, which may become permanent. Fifty-one patients (68%) responded well to systemic corticosteroids, although 11 patients (15%) had further recurrences of the disease. Seven patients (9%) later developed thyroid eye disease after initially having unimuscular orbital myositis. We advocate early institution of corticosteroids in order to avoid permanent restrictive myopathies.
Adolescent↗
Congenital cysts of the iris stroma.
We managed three cases of congenital iris stromal cysts and compared them with 22 cases in the published reports to delineate the clinical features of this condition and determine the best treatment. Our first patient, a 5-month-old girl, had injection of a cyst with trichloroacetic acid, but developed a cataract and endothelial damage to the cornea and the eye was eventually enucleated. Our second patient, a 9-week-old girl, was treated with repeated xenon photocoagulation, drainage of the cyst, and cryotherapy, but required enucleation of the eye. Our third patient, a 5-month-old girl, had excision of the cyst by sector iridectomy with preservation of vision and no recurrence two years later. Our results suggest that complete surgical excision is a superior method of treatment for congenital cysts of the iris stroma.
Cysts↗
Child with multiple congenital anomalies and mosaicism 46, XX/46,XX, del (14)(q32.3).
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Abnormalities, Multiple↗
Evolution of oculomotor nerve palsies.
The management of patients with isolated oculomotor nerve palsies (OMPs) who have normal pupils and no other signs of neurological disease is a controversial issue. A more precise delineation of the clinical course of isolated OMPs may help to determine whether neuroradiologic evaluation is indicated in these cases. We studied 41 patients with isolated third cranial nerve palsies, emphasizing the times of progression and resolution of the oculomotor nerve dysfunction. The average interval from onset to development of maximal ophthalmoplegia failed to differentiate between a microvascular etiology (3.3 days) or posterior communicating artery aneurysm (3 days). Of the 28 patients with diabetic or idiopathic palsies, regardless of pupillary involvement, 68% had improvement of the oculomotor paresis within 4 weeks, 96% within 8 weeks, and 100% within 12 weeks of the onset of symptoms. Our study suggests that patients with pupil-sparing OMPs should be considered for extensive neuroradiologic evaluation only if there is deterioration or failure to improve within 4 to 8 weeks.
Adult↗
Differential intraocular pressure in restrictive strabismus.
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Eye Movements↗
Hang-back lateral rectus recessions for exotropia.
The hang-back recession is a simple, safe alternative to conventional recession. We evaluated the surgical results in 23 consecutive patients undergoing bilateral hang-back lateral rectus recessions and 24 consecutive patients undergoing bilateral conventional lateral rectus recessions. The 6-week postoperative success rate was 78% in the hang-back group and 75% in the conventional group. At the time of the most recent follow-up, the success rate was 64% in the hang-back group and 85% in the conventional group. Dose-response curves were similar for both methods. There were more late overcorrections with the hang-back technique. We suggest modified surgical guidelines for the hang-back recession technique.
Child↗
Retinal hemorrhage following lensectomy and anterior vitrectomy in children.
Lensectomy and anterior vitrectomy were performed on 13 eyes of 10 consecutive children, aged 10 years or less, with congenital or acquired nontraumatic cataracts or subluxed lenses. Operative eyes were examined prospectively to determine the incidence and natural course of hemorrhagic retinopathy following lens extraction. Flame-shaped retinal hemorrhages occurred in five eyes of four patients within 24 hours of surgery. In addition, a small vitreous hemorrhage was seen in one of these patients. All hemorrhages cleared within 3 weeks postoperatively. No statistically significant correlation was found between the occurrence of hemorrhage and patient age, race, sex, or duration of surgery. We conclude that retinal hemorrhage following lensectomy and anterior vitrectomy in children may occur more commonly than previously recognized.
Cataract↗
Surgical technique, visual outcome, and complications of pediatric intraocular lens implantation.
PURPOSE: To evaluate retrospectively the surgical technique, visual outcome, and complications of pediatric cataract extraction (CE) and intraocular lens (IOL) implantation. METHODS: Forty-three patients ages 2 to 12 underwent CE with IOL implantation with a minimum follow up of 1 month. RESULTS: All IOLs were implanted in the posterior chamber with 17 (40%) in the bag, 25 (58%) sulcus fixated, and one (2%) partially in the bag (one haptic in the bag, one in the sulcus). Primary posterior capsulectomy was performed in 12 (28%) cases. A final visual acuity of at least 20/40 was achieved in 26 (60%) and at least 20/80 in 32 (74%). Posterior capsule opacification developed in 18 (42%) and pupillary capture in 7 (16%). Seventeen (40%) patients had postoperative visual acuity worse than 20/40. Of these, nine (53%) had this visual outcome as a result of presumed amblyopia. CONCLUSIONS: Posterior chamber IOL implantation affords a safe and effective method of visual rehabilitation for cataractous children 2 years of age and older. Amblyopia and antecedent posterior segment trauma, rather than IOL-related or surgical complications, are the limiting factors in final visual outcome.
Cataract↗