SCIENTIFIC POSTER_Miriam Garcia Fernandez_6

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 (C3F8) due for a large idiopathic macular hole of more than 500 microns diameter. In all cases we used a xenon light source during surgery with a power of intensity ranging from 50 to 75%. Full clinical examination with best corrected visual acuity (BCVA), fundus examination, fundus photography and optical coherence tomography (OCT) were performed before and after surgery. Fluorescein angiography (FA) was also done in all cases after surgery.

Effectiveness/safety:

One week after surgery the macular hole was closed in all cases and remained closed during follow-up. One month postoperatively, BCVA was lower than prior to surgery. We observed changes in retinal pigment epithelium (RPE) at the posterior pole (mottled hypo- and hyperpigmented alterations) which became more prominent in the following months. Four months postoperatively, retinal atrophic areas and pigment dispersion in the macular area were observed. FA showed blockage of background fluorescence in hyperpigmented areas and hyperfluorecent lesions in areas of RPE atrophy. The clinical characteristics of these lesions and surgical maneuvers implicated that endoillumination with a xenon light source has caused phototoxic injury. Postoperative OCT revealed closure of the macular hole, but retinal thinning and loss of the inner/outer photoreceptor layer and RPE atrophy. The lesions remained unchanged at six months, one, two, three and five years after surgery in all cases with a final BCVA lower than 10/100.

Conclusion:

Macular phototoxic damage remains a potential risk during vitrectomy using xenon light for endoillumination.