Diplopia after refractive surgery: occurrence and prevention.

OBJECTIVES: To report the occurrence of persistent diplopia manifesting after refractive surgery, to describe the different causes of this complication, to provide risk stratification for its occurrence, and to outline minimal screening techniques for its prevention.

METHODS: A retrospective medical record review of patients seen in 2 private strabismus practices who experienced persistent diplopia after refractive surgery.

RESULTS: A total of 28 patients were identified who met the inclusion criteria. The causes of postoperative diplopia could be traced to 1 of 5 mechanisms. These included technical problems, prior need of prisms, aniseikonia, iatrogenic monovision, and improper control of accommodation in patients with strabismus. The recommended screening techniques would have identified all patients in this series as being at risk for postoperative diplopia with the exception of those in whom technical problems were responsible.

CONCLUSIONS: Diplopia can become manifest after refractive surgery. With proper attention paid to risk stratification and recommended screening criteria, the incidence of this complication can be minimized.