[Strabismus and diplopia after refractive surgery].
OBJECTIVE
To evaluate factors that may decompensate a strabismus or lead to diplopia after refractive surgery.


METHODS
Retrospective study of 19 patients, who presented with binocular decompensation after refractive surgery. Mean age at surgery was 38.89 SD 10.26 (27-63) years. Fourteen patients were myopic, 5 hyperopic, and 5 of them had a marked anisometropia. The photo-refractive keratectomy procedure was used in 3 cases, laser-assisted in situ keratomileusis (LASIK) in 13, posterior chamber-IOL)+LASIK in one of them, and bilateral IOL in 2 cases.


RESULTS
There was a prevalence of strabismus of 0.12%. All of our patients had a binocular pathology previous to the refractive surgery. After surgery, 11 patients had an esophoria or esotropia, 3 exophoria or exotropia, 2 vertical deviations, and 3 horizontal and vertical deviations. Several factors often worked simultaneously in the same patient, such as: residual accommodation, refractive overcorrection (hyperopia), visual instability or anisoacuity, high myopia and phoria decompensation, elimination of suppression, dominance change, and a presbyopic age.


CONCLUSIONS
All of our patients had a previous binocular pathology. Binocularity may decompensate by several factors but mostly by myopic overcorrection, accommodation and visual factors, particularly in patients close to or in presbyopic age, in anisometropia and high myopia.
Hospital Clínico San Carlos, Madrid, España. rgomezdeliano@med.ucm.es
R
R
Gómez de Liaño-Sánchez
R
R
Borrego-Hernando
G
G
Franco-Iglesias
P
P
Gómez de Liaño-Sánchez
A
A
Arias-Puente
D000065:Accommodation, Ocular; D000328:Adult; D000367:Age Factors; D004172:Diplopia / Q000453:epidemiology / Q000209:etiology*; D023882:Dominance, Ocular; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D012030:Refractive Errors / Q000503:physiopathology; D054140:Refractive Surgical Procedures / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013285:Strabismus / Q000453:epidemiology / Q000209:etiology*; D015348:Vision, Binocular; D014792:Visual Acuity