Advances in
eISSN: 2377-4290
Submit manuscript...
Editorial Volume 9 Issue 3
Operating microscope induced maculopathy
Burak Turgut
Verify Captcha
Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Please type the correct Captcha word to see email ID.
Verify Captcha
Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Please type the correct Captcha word to see email ID.
Department of Ophthalmology, Faculty of Medicine, Onsekiz Mart University, Turkey
Correspondence: Burak Turgut, Department of Ophthalmology, Faculty of Medicine, Onsekiz Mart University, Turkey, Tel 90533 7128389
Received: May 11, 2019 | Published: June 20, 2019
Citation: Turgut B. Operating microscope induced maculopathy. Adv Ophthalmol Vis Syst. 2019;9(3):82-83. DOI: 10.15406/aovs.2019.09.00351
Abbreviations
OMIM, operating microscope‑induced maculopathy; RPE, retinal pigment epithelium
Keywords
operating microscope, induced, photic maculopathy, retinal injury, toxicity, damage
Editorial
Operating microscope induced maculopathy (OMIM) is a type of photic toxic retinal damage in macular region.1−3 OMIM may occur following anterior segment procedures such as extracapsular cataract extraction or phacoemulsification with intraocular lens implantation, penetrating keratoplasty and pterygium excision or vitrectomy.1−7 OMIM is first described in 1977 as iatrogenic photic maculopathy from light exposure of operating microscopy.1 Visible light (with 400-760 nm) can cause photic macular damage or maculopathy in various forms such as mechanical (photo-disruption), thermal (photocoagulation) and photo-biochemical (solar retinopathy and OMIM). It is considered that OMIM primarily results from photochemical reactions besides thermally enhanced phototoxic reactions from a microscopic illumination involving the outer segments of the photoreceptors and surface of the retinal pigment epithelium (RPE).1−4 Some mechanisms protecting the retina from damaging effects of excessive light include ocular reflexes of blinking and aversion, pupillary construction, absorption by the optical media of a majority of ultraviolet and infrared radiation, protection by xanthophyll pigments from blue light, protection from free radicals and other toxic products generated by the photochemical cascade by melanin. The usage of pupillary mydriatics and eyelid speculum is essential to perform the surgery. Thus, protection from OMIM by pupillary reflex and eyelid blinking is absent during the surgery.1−4 Risk factors for OMIM include the illumination intensity of the operating microscope, the duration of exposure to its light, dilated pupilla, ocular immobility during surgery, emmetropia, associated vascular disease (diabetes mellitus), clear optic media, hypo-pigmentary fundus, the use of hydrochlorothiazide, vitamin A, photosensitizing agents or the supplemental oxygen and deficiency of ascorbic acid. However, surgical time is, the most important causative factor.1−5 OMIM is clinically characterized by a small yellow spot at the fovea and by a central or para/peri-central scotoma and/or metamorphopsia or moderate visual loss occurring in one to four hours following light exposure and diminishing in a few weeks or months.1−6 Ophthalmoscopically diagnosis of OMIM is difficult because of lesion’s small size and normal foveal dense pigmentation.1−4,7,8 Spectral domain optical coherence tomography reveals a loss of the hyperreflective IS OS layer of the central fovea manifesting as an outer lamellar cystic lesion under the fovea as similar to solar maculopathy.9-11 During the operation, to obtain the reduced surgical time and light intensity, and to avoid the use of local or general anesthesia but not topical, minimal utilization of coaxial illumination or the usage of oblique illumination in the light of the operating microscope, the usage of corneal covering with adequate built-in filters in the periods which surgical intervention disrupted and minimal use of supplemental oxygen in young patients can reduce OMIM risk. Topical anesthesia should be the choice for surgery at adequate cases because it provides the continuity of ocular movements and the distribution of the toxic effects of the light. During a vitrectomy, additionally, it is also recommended maintaining a prudent distance between the source of light and the retina and to frequently change its orientation.1−5
Conclusion
In conclusion, any patient with clinically unexplained visual loss and central scotoma and which undergone any uncomplicated ocular surgery that operating microscope was used, should be evaluated for OMIM.
Acknowledgments
None.
Conflicts of interest
The author declares that there is no conflict of interest regarding the publication of this paper.
Authorship contributions
All author has contributed to the concept and design, data collection, literature Search in the work and writing of the manuscript.
References
- Michels M, Sternberg P Jr. Operating microscope‑induced retinal phototoxicity: Pathophysiology, clinical manifestations and prevention. Surv Ophthalmol. 1990;34(4):237−252.
- Irvine AR, Wood I, Morris BW. Retinal damage from the illumination of the operating microscope. An experimental study in pseudophakic monkeys. Arch Ophthalmol. 1984;102(9):1358−1365.
- González Martín-Moro J, Hernández Verdejo JL, Zarallo Gallardo J. Photic maculopathy: A review of the literature (ii). Arch Soc Esp Oftalmol. 2018;93(11):542−550.
- Azzolini C, Brancato R, Venturi G, et al. Updating on intraoperative light‑induced retinal injury. Int Ophthalmol. 1994−1995;18(5):269−276.
- Byrnes GA, Antoszyk AN, Mazur DO, et al. Photic maculopathy after extracapsular cataract surgery. A prospective study. Ophthalmology. 1992;99(5):731−737.
- Karp KO, Flood TP, Wilder AL, et al. Photic maculopathy after pterygium excision. Am J Ophthalmol. 1999;128(2):248−250.
- Knox Cartwright NE, Tole DM, Haynes RJ, et al. Recovery from macular phototoxicity after corneal triple procedure. Cornea. 2007;26(1):102−104.
- Querques L, Querques G, Cascavilla ML, et al. Natural course of photic maculopathy secondary to uncomplicated cataract surgery. Clin Exp Optom. 2014;97(2):175−177.
- Hossein M, Bonyadi J, Soheilian R, et al. Spectral‑domain optical coherence tomography features of mild and severe acute solar retinopathy. Ophthalmic Surg Lasers Imaging. 2011;42:e84−e86.
- Jabbarpoor Bonyadi MH. Bilateral photic maculopathy following pterygium excision: Spectral domain optical coherence tomography findings. J Ophthalmic Vis Res. 2016;11(4):436−438.
- Huang SJ, Gross NE, Costa DL, et al. Optical coherence tomography findings in photic maculopathy. Retina. 2003;23(6):863−866.
©2019 Turgut. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.