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Persistent diplopia following secondary intraocular lens placement in patients with sensory strabismus from uncorrected monocular aphakia
  1. Arif O Khan (arif.khan{at}mssm.edu)
  1. King Khaled Eye Specialist Hospital, Saudi Arabia

    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: Retrospective institutional case series [1982-2005] of patients with sensory strabismus due to 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 newly-noted constant binocular diplopia. The mean period of uncorrected aphakia was 11 years (range 1-20 years, median and mode 11 years). For seven patients diplopia could be eliminated before strabismus surgery using loose prisms in free space and using a haploscope; these seven patients were diplopia-free following successful strabismus surgery (and showed suppression on Worth 4-dot testing). For four patients diplopia could not be eliminated before strabismus surgery (neither with loose prisms in free space nor with a haploscope); these four patients had persistent diplopia despite successful strabismus surgery.

    Conclusions: There is a significant risk for persistent diplopia in this setting (4/11 patients). Inability to eliminate diplopia before strabismus surgery (using loose prisms in free space or a haploscope) predicts persistent diplopia despite ocular re-alignment; such sensory testing should be done while the patient is still aphakic (with an aphakic contact lens) before consideration of secondary PCIOL implantation.

    • aphakia
    • diplopia
    • secondary posterior chamber intraocular lens
    • strabismus

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