Persistent diplopia following secondary intraocular lens placement in patients with sensory strabismus from uncorrected monocular aphakia

Abstract

Aim: To evaluate the incidence of persistent diplopia after secondary posterior chamber intraocular lens (PCIOL) implantation in patients with prolonged uncorrected monocular aphakia with associated sensory strabismus.

Methods: A retrospective institutional case series (1982 to 2005) of patients with sensory strabismus caused by uncorrected monocular aphakia from isolated ocular trauma who underwent secondary PCIOL implantation and subsequent successful strabismus surgery.

Results: Following secondary PCIOL implantation, all 11 identified patients complained of new constant binocular diplopia. The mean period of uncorrected aphakia was 11 years (range 1 to 20; median and mode, 11). In seven patients diplopia could be eliminated before strabismus surgery, using loose prisms in free space or a haploscope, or both; these seven patients were diplopia-free following successful strabismus surgery (and showed suppression on Worth four-dot testing). In four patients diplopia could not be eliminated before strabismus surgery (either with loose prisms in free space or with a haploscope); these four patients had persistent diplopia despite successful strabismus surgery.

Conclusions: There is a significant risk of persistent diplopia in this setting. Inability to eliminate diplopia before strabismus surgery predicts persistent diplopia despite ocular realignment. Sensory testing should be done while the patient is still aphakic (with an aphakic contact lens) before consideration for secondary PCIOL implantation.