Diplopia after cataract surgery*1Comparative results after topical or regional injection anesthesia

Objective To compare the incidence of diplopia after topical or regional injection anesthesia in cataract surgery. Study design Retrospective, noncomparative interventional case series. Participants and methods Three thousand five hundred forty-two consecutive cataract surgeries, performed from March 1998 to December 2001, were studied. Main outcome measures Incidence and mechanisms of diplopia. Results Two thousand one hundred twenty-two patients were operated under regional and 1420 under topical anesthesia. Twenty-four cases of diplopia were observed, 21 (87.5%) in the regional group and 3 (12.5%) after topical anesthesia ( P = 0.005). Eleven cases (45.8%) were secondary to motility problems, all in the regional anesthesia group ( P = 0.006). Eight cases (33.3%) were secondary to refractive errors or intraocular lens luxation, 5 after regional and 3 after topical anesthesia ( P = 0.88). Five cases (20.8%) were secondary to fusion loss, all in the regional anesthesia group ( P = 0.06). Conclusions In our study, topical anesthesia was associated with a lower incidence of diplopia relative to regional injection anesthesia. No cases of diplopia secondary to fusion loss or muscle damage were found after topical anesthesia surgery.