Operating microscope and endoilluminator-induced retinal phototoxic maculopathy after trans-scleral sutured posterior chamber intraocular lens.

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.[12] 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.[34]

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

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