Retinal pjototoxicity after macular hole surgery induced by xenon light: A case series

Introduction Retinal phototoxicity caused by light from the endoilluminator used in vitrectomy has been described. Xenon light, as its radiation is near ultraviolet spectrum, can be one of the most harmful to the retina if adequate filters are not used. Case Reports Case 1 was a 71 year-old Caucasian male who underwent 20-gauge three-port pars plana vitrectomy (PPV) due to a Macular Hole (MH). Case 2 was a 64 year-old Caucasian women underwent 23-gauge PPV due also to a MH, and Case 3 was a 68-year old Caucasian women who underwent also 23-gauge PPV due to same reason. In all cases we performed internal limiting membrane (ILM) peeling and fluid-gas exchange (C3F8). In all of them we used a Xenon light during surgery with an intensity power ranging between 50 and 75%. Full clinical examination, with determined Best Corrected Visual Acuity (BCVA), fundus examination, retinography and Optical Coherence Tomography (OCT), were performed prior and after surgery. Fluorescein angiography (FA) was also performed in all cases after surgery. One week after surgery, the macular hole was closed in all cases and it remained stable during follow-up. One month later, BCVA was lower than before surgery and we observed changes in retinal pigment epithelium at the posterior pole, which remained stable two years after light exposure, with a final BCVA less than 10/100 in all cases.ConclusionMacular phototoxic damage with foveal involvement remains a factual danger during vitrectomy using Xenon light as endoilluminator with inadequate filters.