1. Phototoxic Maculopathy After Scleral Sutured IOL Implantation NC CHO, DW LEE, EY KWEON, MJ KIM Department of Ophthalmology, Chonbuk National University Medical School, Korea

2. The authors do not have any commercial or proprietary interest in the subject matter of this paper

3. Purpose Macular phototoxicity is a rarely reported complication of ocular surgery including complicated cataract extraction, complicated anterior segment procedures, and vitrectomy. An increased risk of phototoxicity is associated with an operating time greater than 100 minutes, focus, retinal temperature and drugs. The aim of this study was to report and emphasize the features of phototoxic maculopathy occurring in patients who underwent scleral- sutured IOL implantation.

4. Method The charts of 75 patients who underwent scleral-sutured intraocular lens implantation at Chonbuk National University Hospital between March 1995 and February 20078 were reviewed. Twenty-one patients underwent combined 3 port pars plana vitrectomy and sutured IOL (vitrectomy group). Fifty-four patients did not do vitrectomy (nonvitrectomy group). All surgeries were performed using the same coaxial illuminated microscope.

5. Method All diagnoses were confirmed by careful fundus examination and fluorescein angiography. An angiographic archive was retrospectively surveyed and interpreted by a retinal specialist to identify eyes with lesions characterized as typical of retinal phototoxicity

6. Results Phototoxic maculopathies were detected in 7 of 75 sutured IOLs(9.33%). Phototoxic maculopathy occurred more frequently in vitrectomy group(3eyes, 14.29%) than nonvitrectoy group(4eyes, 7.41%). Immediately postoperatively, the patients reported decreased vision, purple to red color, scotoma In 5 of the phototoxic maculopathy cases(71.43%), the visual acuity was 20/200 or worse (table 1). Fluorescein angiography showed coarse alterations of the retinal pigment epithelium(figure1,2).

7. Results Fundus photographs show irregular, non elevated oval shaped retinal pigmented lesion and fluorescein angiograms show a irregular hyperfluorescence involving macula with no vascular leakage nor edema. (Figure 1)

8. Results Fundus photography show well-demarcated green-colored, crescent shape degeneration involving macula. Fluorescein angiograms show marginal hyperfluorecence of RPE atrophy with central hypofluoroscence for choroidal ischemic infarction. (Figure 2)

9. NO. Age/s ex OP name Pre-operative refractive error Pre- operarive V.A. Post-operative refractive error symptom Post- operarive V.A. Pt * 167/FOS) Total vitrectomy + scleral fixation Sph+11.5 =Cyl-0.25x86 0.04(0.3) Sph-1.5 =Cyl-1.25x94 Red color0.08(NC) Pt257/MOD) Total vitrectomy + scleral fixation Sph-4.75 =Cyl-4.25x45 0.04(0.3) Sph-4.25 =Cyl-0.5x115 Central scotoma, Decresed visual acuity 0.06(NC) Pt370/FOD) Total vitrectomy + scleral fixation Sph-1.25 =Cyl-0.25x90 0.1(NC) Sph+1.25 =Cyl-6.25x125 Decresed visual acuity FC30(FC50) Pt422/MOS) Scleral fixation Sph-0.5 =Cyl-3.5x0 0.04(NC) Sph-2.0 =Cyl-1.0x179 Decresed visual acuity 0.04(0.08) Pt562/FOD) Scleral fixation Sph+9.5 =Cyl E x0 0.06(0.15) Sph-2.75 =Cyl-1.0x88 Central scotoma0.3(NC) Pt655/MOS) Scleral fixation Sph+13.0 =Cyl-0.5x66 HM(NC) SPh+2.5 =cyl-4.75x180 decresed visual acuity 0.04(NC) Pt756/MOS) Scleral fixation Sph+9.5 =Cyl E x72 FC30(1.0) Sph-2.75 =Cyl-1.0x0 Central Scotoma 0.1(0.3) Result Table1. clinical characters of phototoxic maculopathy Pt * : patient

10. Conclusion Phototoxic maculopathy is a rarely reported complication of intraocular surgery including scleral fixation, vitrectomy Foveal injuries after this surgery are more profound with poor visual outcome. The most important factor in performing surgery is to keep the focused illumination beam off the central fovea and limit exposure times as much as practical. Much work still needs to be done to assess the risk of iatrogenic photoretinal injuries and methods of prevention. The theoretical advantages of filters, indirect illumination system,and corneal shield need to be prospectively evaluated againtst a control group to determine their efficacy.