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.