Refractive Surgery and Strabismus
Authors: Dora Fernández-Agrafojo (MD, PhD)
Instituto INOF. Centro Médico Teknon. Barcelona, Spain
Co-authors: Adrián Farina, Nuria Prieto
ABSTRACT
Purpose:
To describe the sensory and motor outcomes after cataract surgery in a patient with decompensated vertical phoria and diplopia associated with congenital right fourth cranial nerve palsy.
Methods:
A 56-year-old patient presented with vertical diplopia of four months’ duration. Clinical examination revealed decompensated phoria associated with congenital right fourth nerve palsy. Orthoptic evaluation showed hypertropia at distance and near fixation, absence of stereopsis, and decreased visual function according to the VF-14 questionnaire. Slit-lamp examination revealed bilateral phacosclerosis.
Results:
The patient underwent cataract surgery with marked postoperative improvement. At 6 months follow-up, complete reduction of ocular deviation was observed, stereopsis recovered to 40 seconds of arc, and the VF-14 questionnaire improved from 67.3 to 80.76 points. Diplopia disappeared in primary gaze and persisted only in extreme upgaze. No postoperative torsional symptoms were observed.
Conclusions:
Cataract surgery may improve binocular sensory function and compensate ocular deviation in selected patients with decompensated phorias and cranial nerve palsies. Improvement in visual quality may contribute to recovery of binocular fusion and therefore resolution of diplopia.