Phototoxic%20Maculopathy%20After%20Scleral%20Sutured%20IOL%20Implantation

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Phototoxic Maculopathy After Scleral Sutured IOL
Implantation

• NC CHO, DW LEE, EY KWEON, MJ KIM
• Department of Ophthalmology, Chonbuk National
  University Medical School, Korea

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• The authors do not have any commercial or
• proprietary interest in the subject matter of
  this paper

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Purpose

• Macular phototoxicity is a rarely reported
  complication of ocular surgery including
  complicated cataract extraction, complicated
  anterior segment procedures, and vitrectomy.
• An increased risk of phototoxicity is associated
  with an operating time greater than 100 minutes,
  focus, retinal temperature and drugs.
• The aim of this study was to report and emphasize
  the features of phototoxic maculopathy occurring
  in patients who underwent scleral-sutured IOL
  implantation.

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Method

• The charts of 75 patients who underwent
  scleral-sutured intraocular lens implantation at
  Chonbuk National University Hospital between
  March 1995 and February 20078 were reviewed.
• Twenty-one patients underwent combined 3 port
  pars plana vitrectomy and sutured IOL (vitrectomy
  group).
• Fifty-four patients did not do vitrectomy
  (nonvitrectomy group).
• All surgeries were performed using the same
  coaxial illuminated microscope.

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Method

• All diagnoses were confirmed by careful fundus
  examination and fluorescein angiography.
• An angiographic archive was retrospectively
  surveyed and interpreted by a retinal specialist
  to identify eyes with lesions characterized as
  typical of retinal phototoxicity

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Results

• Phototoxic maculopathies were detected in 7 of 75
  sutured IOLs(9.33).
• Phototoxic maculopathy occurred more frequently
  in vitrectomy group(3eyes, 14.29) than
  nonvitrectoy group(4eyes, 7.41).
• Immediately postoperatively, the patients
  reported decreased vision, purple to red color,
  scotoma
• In 5 of the phototoxic maculopathy cases(71.43),
  the visual acuity was 20/200 or worse (table 1).
• Fluorescein angiography showed coarse alterations
  of the retinal pigment epithelium(figure1,2).

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Results

• Fundus photographs show irregular, non elevated
  oval shaped retinal pigmented lesion and
  fluorescein angiograms show a irregular
  hyperfluorescence involving macula with no
  vascular leakage nor edema. (Figure 1)

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Results

• Fundus photography show well-demarcated
  green-colored, crescent shape degeneration
  involving macula. Fluorescein angiograms show
  marginal hyperfluorecence of RPE atrophy with
  central hypofluoroscence for choroidal ischemic
  infarction. (Figure 2)

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Result
NO. Age/sex OP name Pre-operative refractive error Pre-operarive V.A. Post-operative refractive error symptom Post-operarive V.A.
Pt1 67/F OS) Total vitrectomy scleral fixation Sph11.5 Cyl-0.25x86 0.04(0.3) Sph-1.5 Cyl-1.25x94 Red color 0.08(NC)
Pt2 57/M OD) Total vitrectomy scleral fixation Sph-4.75 Cyl-4.25x45 0.04(0.3) Sph-4.25 Cyl-0.5x115 Central scotoma, Decresed visual acuity 0.06(NC)
Pt3 70/F OD) Total vitrectomy scleral fixation Sph-1.25 Cyl-0.25x90 0.1(NC) Sph1.25 Cyl-6.25x125 Decresed visual acuity FC30(FC50)
Pt4 22/M OS) Scleral fixation Sph-0.5 Cyl-3.5x0 0.04(NC) Sph-2.0 Cyl-1.0x179 Decresed visual acuity 0.04(0.08)
Pt5 62/F OD) Scleral fixation Sph9.5 Cyl E x0 0.06(0.15) Sph-2.75 Cyl-1.0x88 Central scotoma 0.3(NC)
Pt6 55/M OS) Scleral fixation Sph13.0 Cyl-0.5x66 HM(NC) SPh2.5 cyl-4.75x180 decresed visual acuity 0.04(NC)
Pt7 56/M OS) Scleral fixation Sph9.5 Cyl E x72 FC30(1.0) Sph-2.75 Cyl-1.0x0 Central Scotoma 0.1(0.3)
Table1. clinical characters of phototoxic maculopathy Pt patient
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Conclusion

• Phototoxic maculopathy is a rarely reported
  complication of intraocular surgery including
  scleral fixation, vitrectomy
• Foveal injuries after this surgery are more
  profound with poor visual outcome.
• The most important factor in performing surgery
  is to keep the focused illumination beam off the
  central fovea and limit exposure times as much as
  practical.
• Much work still needs to be done to assess the
  risk of iatrogenic photoretinal injuries and
  methods of prevention. The theoretical advantages
  of filters, indirect illumination system,and
  corneal shield need to be prospectively evaluated
  againtst a control group to determine their
  efficacy.