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. 1985;83:476–500.

Aphakic cystoid macular edema and the operating microscope: is there a connection?

W J Iliff
PMCID: PMC1298710  PMID: 3832535

Abstract

The literature documenting the phototoxic effect of relatively low intensity light on the retina and the suggestions by several authors that this might influence the development of cystoid macular edema in the aphakic and pseudophakic patient is reviewed. In particular, the possibility that the operating microscope may be a factor has been emphasized. A study is presented, designed to investigate the possibility that the operating microscope is a factor important in the development of cystoid macular edema. No correlation was found. The need for further investigation into other phototoxic effects from the light of the operating microscope is stressed.

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Selected References

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  1. Berler D. K., Peyser R. Light intensity and visual acuity following cataract surgery. Ophthalmology. 1983 Aug;90(8):933–936. doi: 10.1016/s0161-6420(83)80020-7. [DOI] [PubMed] [Google Scholar]
  2. Boldrey E. E., Ho B. T., Griffith R. D. Retinal burns occurring at cataract extraction. Ophthalmology. 1984 Nov;91(11):1297–1302. doi: 10.1016/s0161-6420(84)34150-1. [DOI] [PubMed] [Google Scholar]
  3. Calkins J. L., Hochheimer B. F., D'Anna S. A. Potential hazards from specific ophthalmic devices. Vision Res. 1980;20(12):1039–1053. doi: 10.1016/0042-6989(80)90042-5. [DOI] [PubMed] [Google Scholar]
  4. Calkins J. L., Hochheimer B. F. Retinal light exposure from operation microscopes. Arch Ophthalmol. 1979 Dec;97(12):2363–2367. doi: 10.1001/archopht.1979.01020020579017. [DOI] [PubMed] [Google Scholar]
  5. Calkins J. L., Hochheimer B. F. Retinal light exposure from ophthalmoscopes, slit lamps, and overhead surgical lamps. An analysis of potential hazards. Invest Ophthalmol Vis Sci. 1980 Sep;19(9):1009–1015. [PubMed] [Google Scholar]
  6. Feeney L., Berman E. R. Oxygen toxicity: membrane damage by free radicals. Invest Ophthalmol. 1976 Oct;15(10):789–792. [PubMed] [Google Scholar]
  7. Friedman E., Kuwabara T. The retinal pigment epithelium. IV. The damaging effects of radiant energy. Arch Ophthalmol. 1968 Aug;80(2):265–279. doi: 10.1001/archopht.1968.00980050267022. [DOI] [PubMed] [Google Scholar]
  8. Fuller D., Machemer R., Knighton R. W. Retinal damage produced by intraocular fiber optic light. Am J Ophthalmol. 1978 Apr;85(4):519–537. doi: 10.1016/s0002-9394(14)75250-x. [DOI] [PubMed] [Google Scholar]
  9. GEERAETS W. J., RIDGEWAY D. RETINAL DAMAGE FROM HIGH INTENSITY LIGHT. Acta Ophthalmol Suppl. 1963:SUPPL76–SUPPL76:112. doi: 10.1111/j.1755-3768.1963.tb05170.x. [DOI] [PubMed] [Google Scholar]
  10. Gass J. D., Norton E. W. Cystoid macular edema and papilledema following cataract extraction. A fluorescein fundoscopic and angiographic study. Arch Ophthalmol. 1966 Nov;76(5):646–661. doi: 10.1001/archopht.1966.03850010648005. [DOI] [PubMed] [Google Scholar]
  11. Gladstone G. J., Tasman W. Solar retinitis after minimal exposure. Arch Ophthalmol. 1978 Aug;96(8):1368–1369. doi: 10.1001/archopht.1978.03910060122004. [DOI] [PubMed] [Google Scholar]
  12. Ham W. T., Jr, Mueller H. A., Ruffolo J. J., Jr, Guerry D., 3rd, Guerry R. K. Action spectrum for retinal injury from near-ultraviolet radiation in the aphakic monkey. Am J Ophthalmol. 1982 Mar;93(3):299–306. doi: 10.1016/0002-9394(82)90529-3. [DOI] [PubMed] [Google Scholar]
  13. Ham W. T., Jr, Mueller H. A., Ruffolo J. J., Jr, Millen J. E., Cleary S. F., Guerry R. K., Guerry D., 3rd Basic mechanisms underlying the production of photochemical lesions in the mammalian retina. Curr Eye Res. 1984 Jan;3(1):165–174. doi: 10.3109/02713688408997198. [DOI] [PubMed] [Google Scholar]
  14. Ham W. T., Jr, Mueller H. A., Sliney D. H. Retinal sensitivity to damage from short wavelength light. Nature. 1976 Mar 11;260(5547):153–155. doi: 10.1038/260153a0. [DOI] [PubMed] [Google Scholar]
  15. Ham W. T., Jr, Ruffolo J. J., Jr, Mueller H. A., Guerry D., 3rd The nature of retinal radiation damage: dependence on wavelength, power level and exposure time. Vision Res. 1980;20(12):1105–1111. doi: 10.1016/0042-6989(80)90047-4. [DOI] [PubMed] [Google Scholar]
  16. Henry M. M., Henry L. M., Henry L. M. A possible cause of chronic cystic maculopathy. Ann Ophthalmol. 1977 Apr;9(4):455–457. [PubMed] [Google Scholar]
  17. Hitchings R. A., Chisholm I. H., Bird A. C. Aphakic macular edema: incidence and pathogenesis. Invest Ophthalmol. 1975 Jan;14(1):68–72. [PubMed] [Google Scholar]
  18. Hochheimer B. F. A possible cause of chronic cystic maculopathy: the operating microscope. Ann Ophthalmol. 1981 Feb;13(2):153–155. [PubMed] [Google Scholar]
  19. Hochheimer B. F., D'Anna S. A., Calkins J. L. Retinal damage from light. Am J Ophthalmol. 1979 Dec;88(6):1039–1044. doi: 10.1016/0002-9394(79)90413-6. [DOI] [PubMed] [Google Scholar]
  20. IRVINE S. R. A newly defined vitreous syndrome following cataract surgery. Am J Ophthalmol. 1953 May;36(5):599–619. doi: 10.1016/0002-9394(53)90302-x. [DOI] [PubMed] [Google Scholar]
  21. Irvine A. R., Wood I., Morris B. W. Retinal damage from the illumination of the operating microscope: an experimental study in pseudophakic monkeys. Trans Am Ophthalmol Soc. 1984;82:239–263. [PMC free article] [PubMed] [Google Scholar]
  22. Jaffe N. S., Clayman H. M., Jaffe M. S. Cystoid macular edema after intracapsular and extracapsular cataract extraction with and without an intraocular lens. Ophthalmology. 1982 Jan;89(1):25–29. doi: 10.1016/s0161-6420(82)34855-1. [DOI] [PubMed] [Google Scholar]
  23. Jampol L. M., Kraff M. C., Sanders D. R., Alexander K., Lieberman H. Near-UV radiation from the operating microscope and pseudophakic cystoid macular edema. Arch Ophthalmol. 1985 Jan;103(1):28–30. doi: 10.1001/archopht.1985.01050010032011. [DOI] [PubMed] [Google Scholar]
  24. Jampol L. M., Sanders D. R., Kraff M. C. Prophylaxis and therapy of aphakic cystoid macular edema. Surv Ophthalmol. 1984 May;28 (Suppl):535–539. doi: 10.1016/0039-6257(84)90237-6. [DOI] [PubMed] [Google Scholar]
  25. Keates R. H., Genstler D. E., Tarabichi S. Ultraviolet light transmission of the lens capsule. Ophthalmic Surg. 1982 May;13(5):374–376. [PubMed] [Google Scholar]
  26. Keates R. H., Genstler D. E. UV radiation. Ophthalmic Surg. 1982 Apr;13(4):327–327. [PubMed] [Google Scholar]
  27. Kraff M. C., Sanders D. R., Jampol L. M., Lieberman H. L. Effect of an ultraviolet-filtering intraocular lens on cystoid macular edema. Ophthalmology. 1985 Mar;92(3):366–369. doi: 10.1016/s0161-6420(85)34024-1. [DOI] [PubMed] [Google Scholar]
  28. Kuwabara T. Retinal recovery from exposure to light. Am J Ophthalmol. 1970 Aug;70(2):187–198. doi: 10.1016/0002-9394(70)90001-2. [DOI] [PubMed] [Google Scholar]
  29. Lawwill T., Crockett S., Currier G. Retinal damage secondary to chronic light exposure, thresholds and mechanisms. Doc Ophthalmol. 1977 Dec 30;44(2):379–402. doi: 10.1007/BF00230089. [DOI] [PubMed] [Google Scholar]
  30. Lawwill T. Three major pathologic processes caused by light in the primate retina: a search for mechanisms. Trans Am Ophthalmol Soc. 1982;80:517–579. [PMC free article] [PubMed] [Google Scholar]
  31. Mainster M. A. Solar retinitis, photic maculopathy and the pseudophakic eye. J Am Intraocul Implant Soc. 1978 Jul;4(3):84–86. doi: 10.1016/s0146-2776(78)80112-8. [DOI] [PubMed] [Google Scholar]
  32. Mainster M. A. Spectral transmittance of intraocular lenses and retinal damage from intense light sources. Am J Ophthalmol. 1978 Feb;85(2):167–170. doi: 10.1016/s0002-9394(14)75943-4. [DOI] [PubMed] [Google Scholar]
  33. Mannis M. J., Becker B. Retinal light exposure and cystoid macular edema. Arch Ophthalmol. 1980 Jun;98(6):1133–1133. doi: 10.1001/archopht.1980.01020031123025. [DOI] [PubMed] [Google Scholar]
  34. McDonald H. R., Irvine A. R. Light-induced maculopathy from the operating microscope in extracapsular cataract extraction and intraocular lens implantation. Ophthalmology. 1983 Aug;90(8):945–951. doi: 10.1016/s0161-6420(83)80022-0. [DOI] [PubMed] [Google Scholar]
  35. Meredith T. A., Kenyon K. R., Singerman L. J., Fine S. L. Perifoveal vascular leakage and macular oedema after intracapsular cataract extraction. Br J Ophthalmol. 1976 Nov;60(11):765–769. doi: 10.1136/bjo.60.11.765. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. NICHOLLS J. V. Macular edema in association with cataract extraction. Am J Ophthalmol. 1954 May;37(5):665–672. doi: 10.1016/0002-9394(54)91219-2. [DOI] [PubMed] [Google Scholar]
  37. Naidoff M. A., Slinkey D. H. Retinal injury from a welding arc. Am J Ophthalmol. 1974 May;77(5):663–668. doi: 10.1016/0002-9394(74)90528-5. [DOI] [PubMed] [Google Scholar]
  38. Noell W. K., Walker V. S., Kang B. S., Berman S. Retinal damage by light in rats. Invest Ophthalmol. 1966 Oct;5(5):450–473. [PubMed] [Google Scholar]
  39. Ruffolo J. J., Jr, Ham W. T., Jr, Mueller H. A., Millen J. E. Photochemical lesions in the primate retina under conditions of elevated blood oxygen. Invest Ophthalmol Vis Sci. 1984 Aug;25(8):893–898. [PubMed] [Google Scholar]
  40. Sliney D. H., Wolborsht M. L. Safety standards and measurement techniques for high intensity light sources. Vision Res. 1980;20(12):1133–1141. doi: 10.1016/0042-6989(80)90051-6. [DOI] [PubMed] [Google Scholar]
  41. Sperling H. G., Johnson C., Harwerth R. S. Differential spectral photic damage to primate cones. Vision Res. 1980;20(12):1117–1125. doi: 10.1016/0042-6989(80)90049-8. [DOI] [PubMed] [Google Scholar]
  42. Ts'o M. O., Fine B. S., Zimmerman L. E. Photic maculopathy produced by the indirect ophthalmoscope. 1. Clinical and histopathologic study. Am J Ophthalmol. 1972 May;73(5):686–699. doi: 10.1016/0002-9394(72)90386-8. [DOI] [PubMed] [Google Scholar]
  43. Ts'o M. O., Wallow I. H., Powell J. O., Zimmerman L. E. Recovery of the rod and cone cells after photic injury. Trans Am Acad Ophthalmol Otolaryngol. 1972 Sep-Oct;76(5):1247–1262. [PubMed] [Google Scholar]
  44. Tso M. O. Animal modeling of cystoid macular edema. Surv Ophthalmol. 1984 May;28 (Suppl):512–519. doi: 10.1016/0039-6257(84)90234-0. [DOI] [PubMed] [Google Scholar]
  45. Tso M. O., Fine B. S. Repair and late degeneration of the primate foveola after injury by argon laser. Invest Ophthalmol Vis Sci. 1979 May;18(5):447–461. [PubMed] [Google Scholar]
  46. Tso M. O. Pathology of cystoid macular edema. Ophthalmology. 1982 Aug;89(8):902–915. doi: 10.1016/s0161-6420(82)34698-9. [DOI] [PubMed] [Google Scholar]
  47. Tso M. O. Photic maculopathy in rhesus monkey. A light and electron microscopic study. Invest Ophthalmol. 1973 Jan;12(1):17–34. [PubMed] [Google Scholar]
  48. Tso M. O., Woodford B. J. Effect of photic injury on the retinal tissues. Ophthalmology. 1983 Aug;90(8):952–963. doi: 10.1016/s0161-6420(83)80023-2. [DOI] [PubMed] [Google Scholar]
  49. Yannuzzi L. A. A perspective on the treatment of aphakic cystoid macular edema. Surv Ophthalmol. 1984 May;28 (Suppl):540–553. doi: 10.1016/0039-6257(84)90238-8. [DOI] [PubMed] [Google Scholar]
  50. Yanoff M., Fine B. S., Brucker A. J., Eagle R. C., Jr Pathology of human cystoid macular edema. Surv Ophthalmol. 1984 May;28 (Suppl):505–511. doi: 10.1016/0039-6257(84)90233-9. [DOI] [PubMed] [Google Scholar]

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