A Report of Secondary Restrictive Strabismus and Persistent Diplopia Caused by Retinal Surgery Despite Scleral Explant Removal.

PURPOSE: This case report aimed to introduce a case of persistent diplopia and strabismus and review its clinical manifestations, management, and prognosis, with the aim of helping clinicians gain an in-depth understanding of the surgery for rhegmatogenous retinal detachment.

DESIGN

Case report and literature review.

METHODS

We report a case of persistent diplopia and strabismus despite removal of the scleral explant. Clinical materials were reported, and previous reports on the surgery of the rhegmatogenous retinal detachment were reviewed.

RESULTS

A 49-year-old woman complained of decreased visual acuity in the eye for 1 week and was admitted to our hospital with rhegmatogenous retinal detachment. Under retrobulbar anesthesia, she underwent vitrectomy and scleral buckling surgery. She developed diplopia on the first postoperative day. The operated eye exhibited esotropia and hypotropia, with restricted abduction and upward gaze. To alleviate the symptoms, surgery was scheduled to remove the scleral buckle at the 20-day postoperative follow-up. Unfortunately, there was no significant improvement in diplopia or ocular motility disorders. Four months after retinal detachment surgery, she underwent silicone oil removal and strabismus surgery. Fortunately, the symptoms of diplopia completely disappeared, and upward movement of the eyes was slightly restricted. The patient was very satisfied with the treatment results.

CONCLUSION

Persistent diplopia and restrictive strabismus resulting from rhegmatogenous retinal detachment surgery represent rare yet serious complications that significantly affect patients' quality of life. Symptoms may persist even after scleral buckle removal. Successful outcomes depend on the accurate identification of residual mechanical constraints, which typically require imaging studies and targeted surgical release.