Change in ocular alignment after topical anesthetic cataract surgery

Background  To report the incidence of, and change in ocular misalignment following topical anesthetic cataract surgery. Methods  Prospectively, 160 consecutive patients who were scheduled for cataract surgery under topical anesthesia were evaluated. All patients had a complete ophthalmic examination, including ocular alignment evaluation, just before and 1 day, 1 week, 3 weeks, and 2 months after cataract surgery. Results  Preoperatively, 26 patients had ocular misalignment. Mean deviation in these preexisting misalignment was 7.2 ± 6.8 prism diopters (PD). Postoperatively, the angle of deviation improved to 5.4 ± 7.4 PD. Acquired ocular misalignment after cataract surgery occurred in 12 of 160 patients (8%) at 1 day, and seven of 131 (5%) at 2 months. None of these seven patients sought medical attention for the diplopia. Conclusions  The overall incidence of topical anesthesia-related change in ocular alignment after uneventful cataract surgery was 5%. However, no patients had symptomatic diplopia. Topical anesthetic cataract surgery could abolish the risk of postoperative diplopia and improve the heterophoric status of preexisting misalignment. None of the authors has any financial interest in this study.