Abdul Qayyum, Shaban Khan, Muhammad Afzal.
Post-operative Diplopia in Children with Horizontal Strabismus.
Ophthalmol Update Jan ;12(2):121-6.

Purpose: To study predictability of diplopia in patients with horizontal squints undergoing surgery and frequency of postoperative diplopia in horizontal squints. Setting: Department of Ophthalmology, Bolan Medical College, Quetta. The patients were admitted from pediatric Eye OPD of Bolan Medical College Quetta. 30 eyes were registered for the study. Materials and Methods: This prospective, non-comparative, interventional study was conducted in the department of Ophthalmology, pediatric Ophthalmology clinic, Bolan Medical College, Quetta from February 2013 to January 2014. A total of 30 children (6 to 13 years age) with horizontal squints were registered for the study. Patients with vertical, paralytic squints, syndromes like Duane?s and Browns were excluded from the study. All the patients had complete ophthalmic examinations which include family history, ocular history, corrected visual acuity, slit lamp examination, extra ocular movement, cover/ uncover tests, prism cover tests, and postoperative diplopia test and fundus examination. Surgical procedures comprise of recession/resection of horizontal muscle. Follow-up examination consists of recording best corrected visual acuity, slit lamp examination, extra ocular movement checkup, and prism cover test. The follow up was carried out at first week, second week, one month and second month respectively. Results: Total 30 children were studied whose mean age was 10 years (range from 6-13 years). Out of 30, 6 patients (20%) were between 6-8 years, 9 patients (30%) were between 9-11 years and 15 patients (50%) were within 12-13 years. The sex distribution was 18 (60%) male and 12 (40%) female patients. Out of 30, 24 patients (80%) were concerned about cosmetic correction of strabismus while 6 patients (20%) were concerned about decrease in vision. 15 patients had congenital squints and 15 patients had acquired squints. Out of 30 patients, 18 patients (60%) had 6/6-6/9 visual acuity and 12 patients (40%) had 6/12-6/18 visual acuity in right eye. Out of 30 patients, 15 patients (50%) had 6/6-6/9 visual acuity and 15 patients (50%) had 6/12-6/18 visual acuity in left eye. Out of 30 patients, 18 (60%) had esodeviations and 12 (40%) had exodeviations. Out of 30, 21 patients (70%) did not see double with postoperative diplopia test (preoperative prism testing) during initial examination. The remaining 9 patients (30%) experienced diplopia with postoperative diplopia test. The difference in the incidence of postoperative diplopia based on preoperative prism testing was significant (P<0.001). All the patients were subjected to strabismus surgery (recession/resection). Of 30 patients underwent horizontal muscle surgery for strabismus, 4 patients (13.33%) experienced well-tolerated temporary diplopia after surgery and none of the patients experienced persistent diplopia. Conclusion: 1. The incidence of post-operative diplopia is low in children undergoing horizontal muscle surgery for strabismus. 2. The incidence of permanent (intractable) diplopia is extremely low. 3. The preoperative diplopia test can identify patients who are at the risk of developing post-operative diplopia.

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