Operating microscope light-induced phototoxic maculopathy after transscleral sutured posterior chamber intraocular lens implantation.

PURPOSE: The purpose of this study is to report the features of operating microscope light-induced retinal phototoxic maculopathy after transscleral sutured posterior chamber intraocular lens (TSS PC-IOL) implantation. METHODS: The charts of 118 patients who underwent TSS PC-IOL implantation surgery at Chonbuk National University Hospital (Jeonju, Korea) between March 1999 and February 2008 were retrospectively reviewed. Fourteen patients underwent combined 3-port pars plana vitrectomy and TSS PC-IOL implantation (vitrectomy group), and 104 patients underwent TSS PC-IOL implantation only (nonvitrectomy group). All surgeries were performed under the same coaxial illuminated microscope. All diagnoses were confirmed through careful fundus examination and fluorescein angiography (FA). RESULTS: Diagnoses of retinal phototoxic maculopathy were established in 10 (8.47%) of 118 TSS PC-IOL implantation cases. Phototoxic maculopathy occurred more frequently in the vitrectomy group than in the nonvitrectomy group (6/14 versus 4/104, respectively; P < 0.001, chi-square = 24.21). Affected patients reported decreased vision and were found to have coarse alterations of the retinal pigment epithelium (RPE). In 5 of the phototoxic maculopathy cases (50%), the visual acuity was 20/200 or worse. CONCLUSION: Operating microscope light-induced retinal phototoxic maculopathy can occur more frequently after TSS PC-IOL implantation than after casual cataract surgery, especially when TSS PC-IOL is combined with vitrectomy surgery. Surgeons should take precautions to prevent retinal phototoxicity after TSS PC-IOL implantation and vitrectomy.

Ischemic optic neuropathy after hemiarthroplasty for femoral neck fracture.

Ischemic optic neuropathy due to hemorrhaging remote from visual pathway can occur after surgery. This complication is usually associated with a chronic bleeding disorder, such as gastrointestinal hemorrhage, diabetes, arteriosclerosis, and/or metal poisoning. There are many complications related to cemented hemiarthroplasty in patients who have a femoral neck fracture, such as dislocation, infection, leg length discrepancy, peroneal nerve palsy, and embolism. However, visual loss after this procedure has not previously been reported. In the case reported here, the operation time was short, and there was no massive hemorrhaging. Unilateral visual loss occurred within 3 days of an apparently safe and simple unilateral hemiarthroplasty of the hip.