Poster 1 Joaquin Castro Navarro

Advantages:

To report three cases of retinal phototoxicity caused by Xenon light during idiopathic macular hole surgery.

Methods:

Three eyes (3 patients), two females and one male with idiopathic macular hole, underwent three-port pars plana vitrectomy (Accurus, ALCON, Fort Worth, Tx, EUA) with internal limiting membrane peeling and fluid-gas exchange and fluid-gas exchange (C3F8) due to the presence of an idiopathic macular hole of more than 500 microns of diameter. In all cases we used a Xenon light during surgery with a power of intensity ranging from 50 to 75%. Full clinical examination, with determined Best Corrected Visual Acuity (BCVA), fundus examination, retinography and Optical Coherence Tomography (OCT), were performed prior and after surgery. Fluorescein angiography (FA) was also performed in all cases after surgery.

Effectiveness / Safety:

One week after surgery the macular hole was closed in all cases and it remained stable during follow-up. One month later, BCVA was lower than before surgery and we observed changes in Retinal Pigment Epithelium (RPE) at the posterior pole (mottled hypo and hyperpigmented retinal alterations) which were much more intense in the following months. Four months postoperatively, retinal atrophic areas combined with pigment dispersion in the macular area were appreciated. The FA showed blockage of the fluorescence in hyperpigmented areas and staining of the lesions in RPE atrophic regions. The characteristics of these lesions and surgical conditions implicated the endoilluminator as the source of photic injury. OCT performed postoperatively revealed closure of the macular hole with retinal thinning and loss of the inner/outer photoreceptor layer and RPE in the three patients. The lesions remained unchanged at six months, one, two, three and four years later in all cases with a final BCVA lower than 10/100 in all eyes at their last visit.

Conclusion:

Macular phototoxic damage with foveal involvement remains a factual danger during vitrectomy using Xenon light as endoilluminator, even with maximum precautions.