A 64-year-old male complained of poor visual gain following vitrectomy with trans-scleral fixation of posterior chamber intraocular lens (PCIOL) in his right eye (RE). The surgery lasted two and a half hours and a xenon light source was used for endoillumination. RE had a best corrected visual acuity (BCVA) of 6/36, centered PCIOL, and an amoeboid area of pigmentary alteration at the fovea. Short-wave autofluorescence showed well-demarcated perifoveal hyperautofluorescent areas with spectral domain optical coherence tomography showing loss of photoreceptors and retinal pigment epithelium (RPE) thickening. Diagnosis of microscope and endoilluminator light-induced phototoxic maculopathy was made.[1,2] Despite a 6-week course of oral steroids, he continued to worsen. At 1-year follow-up he had a hyperpigmented foveal scar with BCVA of 4/60 [Fig. 1a-i]. Use of spectral filters and mechanical barriers over the cornea helps to reduce its incidence.[3,4]
Figure 1.
(a, b, and c) Showing pigmentary change at the fovea with pinpoint hyperautofluorescence and hyperautofluorescence rim (red arrow) having disruption of external limiting membrane (ELM) and ellipsoid zone (EZ) (green arrow). (d, e, and f) showing increase in pigmentary change at the fovea, loss of hyperautofluorescence rim and speckled hyper-hypoautofluorescence along with RPE hyperplasia (red arrow) and partial recovery of ELM and EZ (green arrow) at 2 months. (g, h, and i) showing a hypoautofluorescence hyperpigmented foveal scar (yellow arrow) with peripheral isoautofluorescence areas (red arrow) and pigment migration into the inner retina (blue arrow) at 1 year
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
- 1.Kweon EY, Ahn M, Lee DW, You IC, Kim MJ, Cho NC. Operating microscope light-induced phototoxic maculopathy after transscleral sutured posterior chamber intraocular lens implantation. Retina. 2009;29:1491–5. doi: 10.1097/IAE.0b013e3181aa103b. [DOI] [PubMed] [Google Scholar]
- 2.Oh SH, Kim KS, Lee WK. Outer retinal changes in endoilluminator-induced phototoxic maculopathy evident on spectral-domain optical coherence tomography. Clin Exp Optom. 2015;98:381–4. doi: 10.1111/cxo.12273. [DOI] [PubMed] [Google Scholar]
- 3.Michels M, Lewis H, Abrams GW, Han DP, Mieler WF, Neitz J. Macular phototoxicity caused by fiberoptic endoillumination during pars plana vitrectomy. Am J Ophthalmol. 1992;114:287–96. doi: 10.1016/s0002-9394(14)71792-1. [DOI] [PubMed] [Google Scholar]
- 4.Coppola M, Cicinelli MV, Rabiolo A, Querques G, Bandello F. Importance of light filters in modern vitreoretinal surgery: An update of the literature. Ophthalmic Res. 2017;58:189–93. doi: 10.1159/000475760. [DOI] [PubMed] [Google Scholar]