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Preop prisms may help identify risk of diplopia after strabismus surgery

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MADISON, Wisc. — Diagnostic use of prisms before strabismus surgery in adults may help identify a small number of patients with a small but definite risk of intractable postop diplopia, according to one physician.

Burton Kushner, MD, reviewed the records of 424 adults who underwent surgery for constant strabismus. Of those patients, 34% experienced diplopia when tested preoperatively with prisms to simulated surgical outcome. Only 40 patients (9%) had temporary diplopia after surgery, which resolved in all cases by 6 weeks postoperatively. Three patients (0.8%) developed persistent intractable diplopia.

Experiencing diplopia with preoperative prism testing was significantly more likely to result in postoperative diplopia, either temporary or persistent, than if diplopia was not present preoperatively. Patients who did not see double during preop testing with prisms never developed diplopia after surgery. The presence of preop diplopia with prism testing was infrequently predictive of postop diplopia, Dr. Kushner noted.

The study is published in the November issue of Archives of Ophthalmology.