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  • Restrictive diplopia after pterygium removal can be surgically corrected

    Cornea/External Disease, Oculoplastics/Orbit

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    In this retrospective case series, investigators report the characteristics of and surgical approach to patients with restrictive diplopia following pterygium excision.

    Study design

    This analysis included 15 patients who complained of diplopia after having previous pterygium surgery. Patients were treated by a team approach, including a strabismologist and an oculoplastic surgeon or corneal specialist. Forced duction testing was performed intraoperatively and a nasal limbal incision was performed in all cases. Scar tissue was identified and excised; the medial rectus was not recessed in any patient.

    The exposed scleral bed was covered with a conjunctival autograft, amniotic membrane graft or combination of the two. Viscoelastic and dexamethasone was injected around the medical rectus muscle. Twelve patients had a symblepharon ring placed and 11 patients had mitomycin C or 5-FU injections intraoperatively. Topical steroids were used postoperatively. Mean follow up time was 25 months (range 2 weeks–96 months).

    Outcomes

    Preoperatively, all patients had an esotropia after excision of a nasal pterygium, causing diplopia in the abductive field, with a mean onset about 6 months after excision. All patients noted subjective improvement in diplopia following surgery. No patients endorsed diplopia in primary position, and all patients endorsed either resolution or substantial improvement in diplopia in the abductive field of gaze of the affected eye.

    Limitations

    This is a retrospective study with a small sample size. There was a relatively heterogeneous surgical approach to the patients, making it difficult to determine which surgical maneuvers were most effective. While the group of patients underwent the same general approach to treatment, a strict standardized protocol was not used. In addition, some patients with very short follow up (2 weeks) were included in the data set.

    Clinical significance

    Restrictive strabismus after pterygium excision is a difficult condition to treat and often requires the skills of an oculoplastic surgeon. This study provides a variety of surgical maneuvers that resulted in successful resolution of diplopia in this patient group.