Schwarz E C, Gerdemann M, Hoffmann R, Hartmann C
Universitäts-Augenklinik Charité, Berlin.
Ophthalmologe. 1999 Oct;96(10):635-9. doi: 10.1007/s003470050465.
In our Department of Orthoptics we have seen an increasing number of patients suffering from diplopia after cataract surgery with IOL implantation. Between 1993 and 1997 the total number of patients with this problem was 24 (2.7 % of all patients, mean age 71 years, age range 38-88). We addressed the question of whether there is a common pattern of motility dysfunction.
After evaluation of the clinical history and the basic ophthalmological findings the following parameters were examined: binocular function (Bagolini test), squint angles (Maddox cross), ocular motility.
The 24 patients could be divided up into three groups. Group 1 consisted of 9 patients (mean age 82 years, range 64-88) who complained about diplopia because of strabismus incomitans with vertical deviation and restricted motility on the first day after surgery. In 8 of the 9 patients strabismus surgery was done. Group II consisted of 10 patients (mean age 66 years, range 38-77) who noticed diplopia and strabismus within 7 days after surgery. We found various kinds of heterotropia. Seven of these patients were operated on and two had a prism correction. Group III consisted of 5 patients (mean age 67 years, range 61-78). Their already known strabismus paralyticus or concomitans deteriorated, leading to diplopia in some cases. All patients in this group were operated on.
For group I we believe that retro-, para- or peribulbar anesthesia caused the motility dysfunction. In groups II and III it is unlikely that local anesthesia had a causative role. The prolonged disruption of binocular vision and the abrupt change in the sensory situation after the cataract operation with lens implantation may be the leading causes for strabismus or deterioration of a preexisting strabism, respectively.
These patients need a subtil meticulous diagnostic work-up and follow-up because of the possibility of early surgical therapy, which has a good prognosis. Evaluation of binocular vision and eye movements prior to cataract surgery appears to be helpful for later strabismic surgery.
在我们的斜视弱视科，我们发现白内障手术联合人工晶状体植入术后出现复视的患者数量在不断增加。1993年至1997年间，出现这一问题的患者总数为24例（占所有患者的2.7%，平均年龄71岁，年龄范围38 - 88岁）。我们探讨了是否存在共同的眼球运动功能障碍模式。
在评估临床病史和基本眼科检查结果后，检查了以下参数：双眼视功能（Bagolini试验）、斜视角度（马多克斯十字试验）、眼球运动。
24例患者可分为三组。第一组有9例患者（平均年龄82岁，范围64 - 88岁），他们在术后第一天因非共同性斜视伴垂直偏斜和眼球运动受限而抱怨复视。9例患者中有8例行斜视手术。第二组有10例患者（平均年龄66岁，范围38 - 77岁），他们在术后7天内注意到复视和斜视。我们发现了各种类型的斜视。其中7例患者接受了手术，2例进行了棱镜矫正。第三组有5例患者（平均年龄67岁，范围61 - 78岁）。他们已知的麻痹性或共同性斜视病情恶化，在某些情况下导致了复视。该组所有患者均接受了手术。
对于第一组患者，我们认为球后、球旁或球周麻醉导致了眼球运动功能障碍。在第二组和第三组中，局部麻醉不太可能起致病作用。白内障手术联合人工晶状体植入术后双眼视功能的长期破坏以及感觉状态的突然改变可能分别是斜视或原有斜视病情恶化的主要原因。
由于早期手术治疗预后良好，这些患者需要细致的诊断检查和随访。白内障手术前评估双眼视功能和眼球运动似乎有助于后期的斜视手术。
