Resolution of Thyroid Eye Disease-Related Diplopia Following Intentional Myopic Targeting With Unilateral Cataract Surgery

This case report describes the functional resolution of symptomatic diplopia in a patient with stable thyroid eye disease (TED) following unilateral cataract surgery with intentional myopic refractive targeting. A 58-year-old patient with inactive TED presented with persistent distance diplopia and a visually significant unilateral cataract. Prism correction was poorly tolerated, and the patient declined strabismus surgery. Cataract extraction with monofocal intraocular lens implantation was performed, intentionally targeting a postoperative refraction of -3.00 diopters to induce functional anisometropia. At the six-month follow-up, the achieved refraction was -2.25 diopters. The patient reported subjective resolution of diplopia at both distance and near, with improved binocular comfort. Ocular motility remained unchanged, supporting a functional rather than mechanical mechanism. The aim of this case report is to highlight a novel diplopia treatment modality specifically for TED euthyroid patients. Intentional myopic refractive targeting during unilateral cataract surgery may represent a noninvasive functional option for alleviating diplopia in carefully selected patients with stable TED.