This study aimed to test the hypothesis that interruption of macular fusion for an extended period of time is the key event that results in the development of monofixation syndrome in children and adults. This was a retrospective review of patients with unilateral cataract. Of 21 patients with dense cataract, 10 developed monofixation syndrome, eight had normal alignment and three were deemed equivocal with suppression response on Worth 4-dot test at distance fixation but normal stereoacuity. Of 17 control subjects, 15 had normal alignment and two were deemed equivocal – none had monofixation syndrome. Presence of monofixation syndrome in the cataract group was significant in comparison to the control group. The authors conclude that dense unilateral cataract of long-term duration (at least three months) may be associated with development of monofixation syndrome despite good visual acuity after cataract surgery. They advocate prompt removal of dense cataract to lessen risk of reduced binocular vision with monofixation syndrome. 

Development of monofixation syndrome after extraction of dense cataracts.
Sprague-Eustis H, Janot A, Jhaveri C.
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Fiona Rowe (Prof)

Institute of Population Health, University of Liverpool, UK.

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