Bilateral photic maculopathy after extracapsular cataract surgery - A case report

A 42 year old Caucasian female underwent uncomplicated extracapsular cataract extraction with posterior chamber lens implantation in the left eye, using a Zeiss model OpMi-6 operating microscope. Her postoperative course was unremarkable and she achieved a corrected visual acuity of 20/15+3. A lesion consistent with a photoretinal injury was noted inferior to the fovea. Seven months later the patient underwent cataract extraction in the right eye. Special care was taken to minimize light exposure during the procedure, including reducing the microscope illumination, minimizing operating time, intraoperative pharmacologic miosis, and using a corneal light shield. Despite these precautions, the patient developed a photoretinal injury almost identical to that in the contralateral eye. Postoperative corrected visual acuity was 20/15+3. Recent studies have reported incidences of retinal photic injuries from operating microscopes between 0 and 28% of patients. Several risk factors have been identified, including light intensity, intensity of the blue light component, and exposure time. The occurrence of a retinal photic injury in this patient despite precautions, development of bilateral cataracts at a young age, and a strong family history of early cataracts may indicate an inherited susceptibility to light induced damage. The American National Standards Institute (ANSI) is developing a product performance standard which will be applicable to operating microscopes used in ophthalmic surgery. The as yet undetermined role of individual susceptibility to retinal photic injury should be considered in the formulation of this standard.