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JAMA Neurology Sep 2022
Topics: Aged; Blepharoptosis; Diplopia; Female; Humans
PubMed: 35877088
DOI: 10.1001/jamaneurol.2022.1982 -
Journal of AAPOS : the Official... Oct 2022The postoperative diplopia test (PODT) is used to assess the risk of postoperative diplopia in older children and adults prior to strabismus surgery for nonfunctional...
BACKGROUND
The postoperative diplopia test (PODT) is used to assess the risk of postoperative diplopia in older children and adults prior to strabismus surgery for nonfunctional reasons. The purpose of this study was to evaluate the test-retest and interobserver reliability of the PODT and its predictive value in assessing diplopia risk.
METHODS
In the first phase of this study, the repeatability of the PODT method was prospectively assessed with two groups of patients (group 1, test-retest; group 2, interobserver). In the second phase, notes were reviewed retrospectively to evaluate the predictive value of the PODT.
RESULTS
For phase 1, 39 participants were recruited. In group 1, 12 participants showed agreement in the area of suppression for both near and distance fixation; 8 showed variability. In group 2, 10 showed agreement for near, and 9 showed variability; 9 showed agreement for distance, and 10 showed variability. Group 1 differences ranged from 0 to 9 points (median, 0.5; IQR, 0-3); group 2, from 0 to 36 points (median, 1; IQR, 0-4.5). In phase 2, outcomes of 39 strabismus surgeries were reviewed: none of the patients without diplopia on PODT and 2 of 14 patients with diplopia on PODT had persistent diplopia 3 months after surgery.
CONCLUSIONS
Many patients develop diplopia postoperatively, but this generally resolves spontaneously. Current testing procedures have excessive test-retest and interobserver variability and insufficient predictive value to be useful in predicting postoperative diplopia.
Topics: Adult; Child; Humans; Diplopia; Strabismus; Retrospective Studies; Reproducibility of Results; Oculomotor Muscles; Treatment Outcome; Ophthalmologic Surgical Procedures
PubMed: 36156298
DOI: 10.1016/j.jaapos.2022.07.011 -
European Journal of Ophthalmology Jul 2023To compare the surgical outcomes of endoscope-navigation (EN)-assisted orbital decompression and non-EN-assisted orbital decompression for Graves' orbitopathy (GO) and...
PURPOSE
To compare the surgical outcomes of endoscope-navigation (EN)-assisted orbital decompression and non-EN-assisted orbital decompression for Graves' orbitopathy (GO) and to assess the potential clinical advantage of EN in orbital decompression surgery.
METHODS
This retrospective cohort study was performed on 227 orbits of 147 GO patients who underwent EN-assisted orbital decompression (185 orbits) or non-EN-assisted orbital decompression (42 orbits). Assessment included proptosis reduction, best-corrected visual acuity (BCVA), diplopia, ocular restriction and surgical complications.
RESULTS
The proptosis reduction in the EN group was 0.9 mm greater than that in the non-EN group in the entire cohort ( = 0.004) and 1.0 mm greater than that in the non-EN group in the propensity score matching cohort ( = 0.025) at 2 years postoperatively. In all, 78.2% of orbits with sight-threatening GO in the EN group and 52.6% of orbits in the non-EN group showed BCVA improvement ( = 0.026). The proportion of patients with improvement in diplopia was significantly greater in the EN group than in the non-EN group ( = 0.026).
CONCLUSIONS
EN offers anatomical localization and deep-seated tissue visualization in orbital decompression and significantly improves the surgical outcomes for GO.
Topics: Humans; Graves Ophthalmopathy; Diplopia; Retrospective Studies; Treatment Outcome; Decompression, Surgical; Orbit; Exophthalmos; Endoscopes
PubMed: 36718496
DOI: 10.1177/11206721231152628 -
Journal of AAPOS : the Official... Dec 2020To investigate the likelihood of surgeons performing lower blepharoplasties having cases of diplopia persisting for more than 1 week after surgery.
PURPOSE
To investigate the likelihood of surgeons performing lower blepharoplasties having cases of diplopia persisting for more than 1 week after surgery.
METHODS
An anonymous survey (13 questions) on the frequency and characteristics of persistent diplopia (lasting >1 week) after lower blepharoplasty was sent to members of the American Society of Ophthalmic Plastic and Reconstructive Surgery.
RESULTS
Of 703 members, 371 (52.8%) responded to the survey. Of these, 86 (23.2%) had at least 1 case of persistent diplopia following lower blepharoplasty. Complete data were available for 84 of the 86 physicians. The inferior oblique muscle was involved in 51 cases (61%), the inferior rectus muscle in 7 cases (8%), both the inferior oblique and inferior rectus muscles in 4 cases (5%), and the muscle involved was not identified in 22 patients (26%). The diplopia was paretic in 49 patients (58%) and restrictive in 35 (42%). The diplopia persisted in primary position in 7 patients (8%), in gaze positions other than primary position in 16 patients (19%), and resolved completely in 61 patients (73%).
CONCLUSIONS
There is a significant chance of surgeons performing lower blepharoplasties having at least 1 case of diplopia lasting over a week postoperatively. Our survey results indicate that this complication may be more common than is suggested by the medical literature.
Topics: Blepharoplasty; Diplopia; Eyelids; Humans; Oculomotor Muscles; Surveys and Questionnaires
PubMed: 33246110
DOI: 10.1016/j.jaapos.2020.07.017 -
Clinical & Experimental Optometry Sep 2014Diplopia is an infrequent but distressing adverse outcome after uncomplicated cataract surgery. Many factors may contribute to the occurrence of this problem, including... (Review)
Review
Diplopia is an infrequent but distressing adverse outcome after uncomplicated cataract surgery. Many factors may contribute to the occurrence of this problem, including prolonged sensory deprivation resulting in disruption of sensory fusion, paresis of one or more extraocular muscles, myotoxic effects of local anaesthesia, optical aberrations (for example, aniseikonia) and pre-existing disorders (for example, thyroid orbitopathy). The purpose of this review is to present the aetiology and clinical features of diplopia after cataract surgery and to discuss the possible modalities for the prevention and treatment of this frustrating complication.
Topics: Cataract Extraction; Diplopia; Disease Management; Humans; Oculomotor Muscles; Postoperative Complications
PubMed: 25138745
DOI: 10.1111/cxo.12197 -
Journal of Binocular Vision and Ocular... 2022The evaluation and management of vertical strabismus is more challenging and nuanced than that of horizontal strabismus. Vertical strabismus often results from a variety...
The evaluation and management of vertical strabismus is more challenging and nuanced than that of horizontal strabismus. Vertical strabismus often results from a variety of restrictive or paretic causes, which can be further characterized as either acquired or congenital. In some cases, identifying the correct etiology of the strabismus can mean uncovering a potentially life-threatening condition, such as a brain tumor or stroke. The keys to identifying the correct diagnosis are, first and foremost, a careful history, and secondly, a detailed examination. The characteristics, etiologies, and evaluation of vertical strabismus will be reviewed here.
Topics: Humans; Diplopia; Strabismus
PubMed: 36279479
DOI: No ID Found -
Romanian Journal of Ophthalmology 2022A 36-year-old female patient presented to our clinic with a two months history of diplopia and dizziness. The symptoms appeared gradually and increased in frequency and...
A 36-year-old female patient presented to our clinic with a two months history of diplopia and dizziness. The symptoms appeared gradually and increased in frequency and intensity. She had no significant medical history and she did not take any medication. A full ophthalmological consult was performed, which revealed restricted ocular motility in the left eye (LE), in left gaze. Otherwise, the examination showed no pathological findings: best corrected visual acuity (BCVA) both eyes (OU) 1 (Snellen chart), normal slit lamp examination and pupillary reflexes, normal intraocular pressure (IOP) and fundus aspect. Diplopia tests revealed a horizontal diplopia, exacerbated in left gaze. Sixth nerve palsy suspicion was raised and the patient was directed to the neurology department. Following magnetic resonance imaging, with angiographic sequence, a complex intracerebral vascular malformation that interacted with the cranial nerves and determined horizontal diplopia, was found. For a correct diagnosis, we needed a good collaboration between various medical specialties, especially ophthalmology and neurology, because patients with diplopia often present for the first time at the ophthalmologist. BCVA = best corrected visual acuity, IOP = intraocular pressure, LE = left eye, RE = right eye.
Topics: Abducens Nerve Diseases; Adult; Diplopia; Female; Humans; Intraocular Pressure; Tonometry, Ocular; Visual Acuity
PubMed: 35531446
DOI: 10.22336/rjo.2022.15 -
La Revue de Medecine Interne Dec 2017Diplopia is defined as "double vision" when looking at a single object. Monocular diplopia is related to an ocular disorder and must be differentiated from binocular... (Review)
Review
Diplopia is defined as "double vision" when looking at a single object. Monocular diplopia is related to an ocular disorder and must be differentiated from binocular diplopia which is secondary to ocular misalignment. The examination of the patient with binocular diplopia is often challenging for non-specialists. However, a careful and systematic clinical examination followed by targeted ancillary testing allows the clinician to localize the lesion along the oculomotor pathways. The lesion may involve the brainstem, the ocular motor nerves III, IV or VI, the neuromuscular junction, the extraocular ocular muscles, or the orbit. Causes of binocular diplopia are numerous and often include disorders typically managed by internal medicine such as inflammatory, infectious, neoplastic, endocrine, and metabolic disorders. In addition to treating the underlying disease, it is important not to leave diplopia uncorrected. Temporary occlusion of one eye by applying tape on one lens or patching one eye relieves the diplopia until more specific treatments are offered should the diplopia not fully resolve.
Topics: Abducens Nerve; Diabetic Retinopathy; Diagnosis, Differential; Diplopia; Humans; Internal Medicine; Neoplasms; Oculomotor Nerve; Oculomotor Nerve Diseases; Orbital Diseases; Paraneoplastic Syndromes, Ocular; Trochlear Nerve
PubMed: 28325621
DOI: 10.1016/j.revmed.2017.01.016 -
Survey of Ophthalmology 2019Binocular diplopia and right hemifacial numbness developed in a 52-year-old woman after resection of a right temporal lobe glioblastoma. Based on the Parks-Bielschowsky...
Binocular diplopia and right hemifacial numbness developed in a 52-year-old woman after resection of a right temporal lobe glioblastoma. Based on the Parks-Bielschowsky 3-step test, she was diagnosed with a right cranial nerve (CN) IV palsy in addition to right CN V dysfunction. Iatrogenic diplopia may result from temporal lobe surgery due to the intimate relationship of CN IV and CN III to the mesial temporal lobe. In addition, injury to CN V within Meckel cave is believed to be the cause of facial numbness in some patients after temporal lobe surgery. The anatomy of the intracranial portion of CN IV is reviewed, and the etiologies of CN IV palsy are discussed.
Topics: Brain Ischemia; Cranial Nerve Diseases; Diagnosis, Differential; Diplopia; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Temporal Lobe; Visual Fields
PubMed: 29959965
DOI: 10.1016/j.survophthal.2018.06.005 -
Journal of AAPOS : the Official... Apr 2021To evaluate the characteristics of diplopia in children at a single tertiary eye care center.
PURPOSE
To evaluate the characteristics of diplopia in children at a single tertiary eye care center.
METHODS
The medical records of patients with diplopia onset at age 18 years or younger presenting during the period 2015-2018 were reviewed retrospectively. Demographic information, clinical characteristics, diagnoses, treatment, and outcome data were collected. The exact χ test was used to compare groups and select post hoc analyses were performed using the Fisher exact or exact χ tests.
RESULTS
A total of 244 patients (average age, 12.2 years at presentation) were included. The most common clinical diagnoses were nonparalytic strabismus (49.2%), trauma (9.4%), and cranial nerve palsies (9%). There was no statistically significant difference in median age of diplopia onset in those with nonparalytic strabismus, cranial nerve palsies, and vision- or life-threatening conditions. There was a statistically significant difference in timing of onset of diplopia at presentation in vision- or life-threatening conditions compared to nonparalytic strabismus (P < 0.0001) and cranial nerve palsies (P = 0.01) and for neurologic symptoms in vision- or life- threatening conditions compared to nonparalytic strabismus (P = 0.032) and cranial nerve palsies (P = 0.0051). In patients with more than one neurologic symptom, the majority (58.3%) had a vision- or life-threatening condition. Initial interventions included observation (28.7%), prisms (18.4%), updating refractive correction (14.3%), and strabismus surgery (11.1%). In patients with follow-up data, 5.3% had resolution of diplopia prior to their clinic visit, and 46.6% had resolution after initial intervention.
CONCLUSIONS
In our study cohort, most children who presented with diplopia had nonemergent conditions. In those with life-threatening conditions, diplopia tended to have an acute onset and associated neurologic signs and visual symptoms.
Topics: Adolescent; Child; Diplopia; Humans; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Retrospective Studies; Strabismus
PubMed: 33857602
DOI: 10.1016/j.jaapos.2020.10.015