Iatrogenic Injury from Ophthalmic Light Sources

Light from the operating microscope [17] or vitrectomy endoilluminator

[11] can cause a retinal burn.

• The incidence of photic maculopathy during cataract surgery can reach 7%.

• Prolonged operation time is a significant risk factor.

• The symptoms and prognosis depend on the location and severity of the lesion.

• After anterior segment surgery, complaints are rare since the visual acuity is not significantly affected. Even when a paracentral scotoma is documented, it may improve with time [14].

• After vitrectomy, the complaints and outcome may be substantially worse since the light is held much closer to the retina and its position can be stationary for extended periods10 [11]. This is an increasingly serious threat today with the light sources becoming stronger (see Chap. 2.9).

• Ophthalmoscopically, the typical finding is a perifoveal, round to oval area of RPE change.11 The shape of the lesion corresponds to the shape of the illuminating source.12 The lesion is usually inferior to the fovea and outside the foveal avascular zone. Progressive pigmentation of the lesion may be observed over the next several months, distinguishing the acute maculopathy from an old scar.

• The FLAG shows a sharply demarcated, mottled hyperfluorescent lesion.

Table 3.2.1 provides a summary of recommendations to prevent iatrogenic photic retinal trauma from ophthalmic light sources.

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