Light-induced maculopathy from the operating microscope in extracapsular cataract extraction and intraocular lens implantation.

A characteristic macular lesion has been noted in six patients who underwent extracapsular cataract extraction with posterior chamber lens implantation. The lesion appeared similar to that which other investigators have produced in monkeys as a response to the coaxial illumination of the operating microscope. On the first or second postoperative day, the lesion appeared as an oval area of mild yellow-white discoloration of the retina; gradually it developed mottled pigmentation over the next few weeks. The pigmentary changes were often subtle, but fluorescein angiography revealed a characteristic sharply circumscribed lesion. In most of our patients the lesion was just above or below the foveola, so that central vision returned to normal, but a paracentral scotoma was present. These findings should encourage the clinician to heed the warnings of those laboratory studies which have shown the phototoxic potential of the operation microscope's unfiltered coaxial illumination and force us to re-examine our filters and operating techniques.