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Amer. Orthoptic Jrnl. 58(1):39-44 (2008); doi:10.3368/aoj.58.1.39
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Symposium: Standards of Care and Controversies in the Treatment of Adult Strabismus

Causes and Prevention of Diplopia After Refractive Surgery

Burton J. Kushner, M.D.

From the Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin

Correspondence: Requests for reprints should be addressed to: Burton J. Kushner, M.D., Dept. of Ophthalmology and Visual Sciences, Univ. of Wisconsin, 2870 University Ave., Suite 206, Madison, WI 53705; e-mail:bkushner{at}wisc.edu

Background and Purpose: To describe the decompensation of strabismus or the occurrence of persistent diplopia after refractive surgery, list different causes for these complications, outline risk stratification for their occurrence, and outline screening techniques for their prevention.

Patients and Methods: A retrospective review of patients examined and treated for persistent diplopia or decompensated strabismus after refractive surgery.

Results: The review identified thirty-seven patients. The etiologies of the complications were either due to technical problems or judgment errors with respect to planning. This latter category included the failure to recognize prior need of prisms, predictable aniseikonia, the surgical creation of monovision, and improper control of accommodation in strabismic patients. From this series recommended screening criteria are outlined.

Conclusions: Decompensation of strabismus or persistent diplopia can occur after refractive surgery. These complications can be minimized with careful attention to the identification of risks preoperatively.

Key words: strabismus, diplopia, LASIK, refractive surgery, monovision






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