A 10-year-old boy was referred to our clinic with the complaint of diplopia. He described a vertically displaced image that disappeared with chin-up posturing. He noted this vision change after cranial surgery for removing a craniopharyngioma 4 months prior. His preoperative ophthalmic examination was normal except for bilateral myopia. Cycloplegic refraction revealed − 2.50 diopters in the right eye and − 2.00 diopters in the left eye. Both eyes had a BCVA of 1.0. Prism-cover testing showed 11 PD XT at the primary position. Ocular motility testing revealed normal and symmetric eye movement bilaterally; however, the Hess chart demonstrated mild supraduction overaction in the right eye. Fundus examination revealed bilateral optic atrophy, and VF examination showed bitemporal hemianopia []. Since the patient could eliminate the diplopia with an adapted head posture, we proceeded with observation only. One year later, the patient noticed diplopia only with an upward gaze. The Worth four-dot test revealed left-eye suppression. The last follow-up was 6 years after the first visit, and the optic disc, VF defect, and XT remained stable. His BCVA was 1.0 bilaterally with a correction of − 4.75 diopters in the right eye and − 4.00 diopters in the left eye. The patient admitted that he seldom experienced diplopia and could simply ignore it when it occurred.
A 40-year-old man complained of diplopia 4 days after trabeculectomy of the right eye 4 months before visiting our clinic. His corrected vision was 0.5 with − 5.50-diopter correction in the right eye and 1.0 with − 3.50-diopter correction in the left eye. Fundus examination revealed enlarged disc cupping in the right eye and a normal left eye. His VF examination showed an extremely constricted VF in the right eye, with only 7.5° × 5° remaining in the central island []. Prism-cover testing revealed 20 PD XT at the primary position. Ocular motility testing demonstrated no ophthalmoplegia. To eliminate the diplopia, we performed a right LRM recession of 7.0 mm. One month postoperatively, prism-cover testing revealed 3 PD right hypotropia. The patient described alleviation in diplopia, although it did occur sometimes. He also reported improved stereoacuity.