Prospective incidence of photic maculopathy after cataract surgery

Spectral Dependence of Light Exposure on Retinal Pigment Epithelium Disruption in Living Primate Retina

Purpose

RPE disruption with light exposures below or close to the American National Standards Institute (ANSI) photochemical maximum permissible exposure (MPE) have been observed, but these findings were limited to two wavelengths. We have extended the measurements across the visible spectrum.

Methods

Retinal imaging with fluorescence adaptive optics scanning light ophthalmoscopy (FAOSLO) was used to provide an in vivo measure of RPE disruption at a cellular level. The threshold retinal radiant exposures (RREs) for RPE disruption (localized detectable change in the fluorescence image) were determined at 460, 476, 488, 530, 543, 561, 594, 632, and 671 nm (uniform 0.5° square exposure) using multiples locations in 4 macaques.

Results

FAOSLO is sensitive in detecting RPE disruption. The visible light action spectrum dependence for RPE disruption with continuous wave (CW) extended field exposures was determined. It has a shallower slope than the current ANSI blue-light hazard MPE. At all wavelengths beyond 530 nm, the disruption threshold is below the ANSI blue-light hazard MPE. There is reciprocity of exposure irradiance and duration for exposures at 460 and 594 nm.

Conclusions

We measured with FAOSLO the action spectrum dependence for photochemical RPE disruption across the visible light spectrum. Using this in vivo measure of phototoxicity provided by FAOSLO, we find that thresholds are lower than previously measured. The wavelength dependence in our data is considerably shallower than the spectral dependence of the traditional ANSI blue-light hazard, emphasizing the need for more caution with increasing wavelength than expected.

Mechanisms and Treatment of Light-Induced Retinal Degeneration-Associated Inflammation: Insights from Biochemical Profiling of the Aqueous Humor

Ocular inflammation contributes to the pathogenesis of blind-causing retinal degenerative diseases, such as age-related macular degeneration (AMD) or photic maculopathy. Here, we report on inflammatory mechanisms that are associated with retinal degeneration induced by bright visible light, which were revealed while using a rabbit model. Histologically and electrophysiologically noticeable degeneration of the retina is preceded and accompanied by oxidative stress and inflammation, as evidenced by granulocyte infiltration and edema in this tissue, as well as the upregulation of total protein, pro-inflammatory cytokines, and oxidative stress markers in aqueous humor (AH). Consistently, quantitative lipidomic studies of AH elucidated increase in the concentration of arachidonic (AA) and docosahexaenoic (DHA) acids and lyso-platelet activating factor (lyso-PAF), together with pronounced oxidative and inflammatory alterations in content of lipid mediators oxylipins. These alterations include long-term elevation of prostaglandins, which are synthesized from AA via cyclooxygenase-dependent pathways, as well as a short burst of linoleic acid derivatives that can be produced by both enzymatic and non-enzymatic free radical-dependent mechanisms. The upregulation of all oxylipins is inhibited by the premedication of the eyes while using mitochondria-targeted antioxidant SkQ1, whereas the accumulation of prostaglandins and lyso-PAF can be specifically suppressed by topical treatment with cyclooxygenase inhibitor Nepafenac. Interestingly, the most prominent antioxidant and anti-inflammatory benefits and overall retinal protective effects are achieved by simultaneous administrating of both drugs indicating their synergistic action. Taken together, these findings provide a rationale for using a combination of mitochondria-targeted antioxidant and cyclooxygenase inhibitor for the treatment of inflammatory components of retinal degenerative diseases.

Photic maculopathy: A review of the literature (ii)

The human retina, as transducer of light energy, is especially exposed to light toxicity. Solar maculopathy has been the only form of photic maculopathy for millennia, often secondary to the observation of an eclipse. During the last century, technological advances have led to the appearance of new forms of photic maculopathy, related to the exposure to new forms of artificial light, such as welding devices and lasers. In recent years the general use of laser pointers has led to an upturn in interest in this pathology. The aim of this review is to offer an integrated view of the different types of photic maculopathy. Due to the extension of the topic, the review is presented divided into 2 parts. In this second part, atomic bomb maculopathy, laser maculopathy, iatrogenic forms of photic maculopathy, and foveomacular retinitis are presented.

Hydrogen-rich saline ameliorates the retina against light-induced damage in rats

Oxidative reactions are thought to be a major cause of light-induced retinal degeneration. This study was designed to investigate the effects of hydrogen-rich saline (HRS) on the prevention and treatment of light-induced retinal injury in rats. Male Sprague–Dawley rats were divided randomly into three groups: light damage, HRS prevention (5 ml/kg, 30 min before intensive light exposure), and HRS treatment (5 ml/kg per day for 5 days, after intensive light exposure), respectively. The right eye of each rat was exposed to 5000 lux constant white light-emitting diode (LED) light for 3 h, and the left eye was covered to serve as the blank control. Electroretinograms were recorded 5 days later, and the thickness of the outer nuclear layer (ONL) was measured after hematoxylin and eosin (H&E) staining. The results showed that the electroretinogram b-wave amplitudes and the mean ONL thicknesses of rats were significantly greater in the HRS prevention (P < 0.001) and treatment (P < 0.001) groups than in the light damage. These results indicated that peritoneal injection of HRS provides protection and treatment against light-induced retinal degeneration in rats.

Ocular coherence tomography of symptomatic phototoxic retinopathy after cataract surgery: a case report

Introduction

High-resolution ocular coherence computed tomography enables unprecedented visualization of the retinal microarchitecture. To the best of our knowledge, this is the first report of high-resolution ocular coherence tomography findings in the healed form of photic post-cataract retinopathy.

Case presentation

A 76-year-old Caucasian man complained of paracentral scotoma, persisting for six weeks after cataract surgery.

Conclusion

Ocular coherence tomography demonstrated a localized juxta-foveal area of retinal atrophy involving the photoreceptor layer, and the retinal pigment epithelium layer.

Retinal light toxicity

The ability of light to enact damage on the neurosensory retina and underlying structures has been well understood for hundreds of years. While the eye has adapted several mechanisms to protect itself from such damage, certain exposures to light can still result in temporal or permanent damage. Both clinical observations and laboratory studies have enabled us to understand the various ways by which the eye can protect itself from such damage. Light or electromagnetic radiation can result in damage through photothermal, photomechanical, and photochemical mechanisms. The following review seeks to describe these various processes of injury and many of the variables, which can mitigate these modes of injury.

Intraperitoneal Injection ofGinkgo bilobaExtract Enhances Antioxidation Ability of Retina and Protects Photoreceptors After Light-Induced Retinal Damage in Rats

PURPOSE

To investigate the effect of Ginkgo biloba extract EGb 761, a free-radical scavenger, on the antioxidation capability of retina after light-induced retinal damage in rats in an attempt to understand the mechanism by which EGb 761 protects the photoreceptors after light-induced retinal damage.

METHODS

Seventy-two female Sprague-Dawley (SD) rats were evenly randomized into normal control group (NC group), light-induced retinal damage model group (M group), model + normal saline group (MN group), and model + EGb 761 group (ME group). Light-induced retinal damage model was induced via exposure to white light at 2740 +/- 120 lux for 6 hr. Rats in MN group and ME group were intraperitoneally injected daily with normal saline and 0.35% EGb 761 (100 mg/kg), respectively, 1 week before and 2 weeks after light exposure. The levels of malondialdehyde (MDA), total superoxide dismutase (T-SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) in the retinal tissues were determined 24 hrs after light exposure; photoreceptor apoptosis was detected 4 days after light exposure. One and 2 weeks after light exposure, histopathologic examination was carried out, and the outer nuclear layer (ONL) thickness (number of nuclei) in the superior and inferior retina was counted.

RESULTS

Twenty-four hours after exposure, the MDA levels in the other three groups were significantly higher than that in the NC group (p < 0.05); those in the M and MN groups were similar to each other (p > 0.05); and that of the ME group was significantly lower than those in the M and MN group (p < 0.05). The activities of T-SOD, GSH-Px, and CAT were similar in the M and MN groups (p > 0.05); the activities in the M and MN groups were significantly lower than those in the NC and ME groups (p < 0.05); and the activities in the ME group were significantly higher than those in the M and MN groups (p < 0.05). Four days after exposure, the apoptotic photoreceptors within the ONL in the ME group were obviously fewer than those in the M and MN groups. One week and 2 weeks after exposure, the ONL thickness (number of nuclei) in the ME group was more than that in the M and MN groups but less than that in the NC group.

CONCLUSIONS

Intraperitoneal injection of EGb 761 can enhance the antioxidation ability of retina and partially inhibit the apoptosis of photoreceptors, thus exert a protective effect on photoreceptors.

Prevention of suture exposure in transscleral intraocular lens fixation: an original technique

BACKGROUND

In this retrospective study, we evaluated our surgical outcomes of transscleral intraocular lens (IOL) fixation and introduced a simple, quick, and effective method to fixate and bury the sutures in the sclera to avoid suture exposure.

METHODS

Eyes were divided into 3 groups according to surgical technique. Half-thickness scleral flaps were prepared, and polypropylene suture ends were cut short in group 1 (12 eyes). Suture ends were left long without flaps in group 2 (47 eyes) and were buried into the scleral tunnel in group 3 (21 eyes).

RESULTS

The suture exposure rate was significantly lower in group 3 (0%) compared with group 2 (p = 0.006) and group 1 (p = 0.040). There was no significant difference in group 1 (25%) compared with group 2 (27.6%) (p = 1.000).

INTERPRETATION

Burying the suture ends into the scleral tunnel is a simple, safe, and effective technique for avoiding suture exposure in scleral-fixated IOL implantation.

Comparison of Outcomes of Primary Scleral-Fixated versus Primary Anterior Chamber Intraocular Lens Implantation in Complicated Cataract Surgeries

OBJECTIVE

To compare the visual outcomes and complication profiles of primary scleral-fixated intraocular lens (SFIOL) versus primary anterior chamber intraocular lens (ACIOL) implantation in cataract surgeries complicated by inadequate capsular support.

DESIGN

Retrospective, interventional, comparative cases series.

PARTICIPANTS

Thirty-six eyes of 36 patients undergoing SFIOL implantation (group 1) and 46 eyes of 46 patients undergoing ACIOL implantation (group 2).

METHODS

Retrospective analysis of medical records of a consecutive series of complicated cataract surgeries with primary SFIOL or ACIOL implantation.

MAIN OUTCOME MEASURES

Postoperative best-corrected visual acuity (BCVA), intraoperative and postoperative complications, if any, and postoperative corneal endothelial cell counts. A multiple linear regression model was constructed with postoperative BCVA as the dependent variable and with IOL group (SFIOL vs. ACIOL), preoperative BCVA, surgeon's operative experience, planned operation, and patient's age as independent variables.

RESULTS

Fifty-eight percent (group 1) and 37% (group 2) of patients underwent phacoemulsification, whereas the rest underwent extracapsular cataract extraction. The mean postoperative follow-up was 33.4+/-17.9 months (range, 6-61 months). Postoperative Snellen BCVA of 20/40 or better was achieved in 47.2% (group 1) and 71.7% (group 2) of patients (P = 0.038). Regression analysis showed that primary ACIOL implantation was associated with a significantly better postoperative BCVA of -0.157 on the logarithm of minimum angle of resolution scale (95% confidence interval, -0.306 to -0.007; P = 0.040), compared with primary SFIOL implantation. Although both the number of eyes with complications and the total number of complications were higher in the SFIOL group, the differences in early (P = 0.073) and late (P = 0.377) complications were not statistically significant.

CONCLUSIONS

The results indicate that satisfactory results are achieved with primary implantation of current open-loop ACIOLs during cataract surgery complicated by loss of posterior capsule integrity. Eyes with these IOLs fared better than a cohort of eyes undergoing SFIOL implantation in a similar situation, at intermediate-term follow-up. Further prospective clinical trials with longer follow-up may help to evaluate the long-term visual outcomes and complication profiles after primary implantation of these lenses.

Detection of lipid peroxidation in light-exposed mouse retina assessed by oxidative stress markers, total hydroxyoctadecadienoic acid and 8-iso-prostaglandin F2α

Exposure to excessive light induces retinal photoreceptor cell damage, which may involve lipid peroxidation. Morphological changes and the detection of internucleosomal DNA fragmentation confirmed the retinal damage caused by exposure of the retina of Balb/c mice to white fluorescent light (5000 lux, 2 h). The total amounts of hydroxyoctadecadienoic acid (tHODE) and 8-iso-prostaglandin F2alpha (8-iso-PGF2alpha) in the retinas obtained from light-exposed mice were assessed after reduction and saponification. In this method, both the free and ester forms of hydroperoxides, hydroxides, and ketones of linoleic acid are measured as tHODE by gas chromatography-mass spectrometry (GC-MS) analysis. When compared with controls, a significant increase in the concentrations of tHODE and 8-iso-PGF2alpha was observed 24 h after light exposure. Furthermore, the stereoisomeric ratio (Z,E)-HODE/(E,E)-HODE decreased after light exposure, suggesting the involvement of free-radical-mediated peroxidation. By the immunohistochemical technique, it was confirmed that 8-iso-PGF2alpha increased in the inner plexiform layer (IPL), outer plexiform layer (OPL), rod outer segment, and choroidal layer, while 13-HODE increased in the OPL and rod inner segment after light exposure. These results demonstrate that tHODE and 8-iso-PGF2alpha assessed by the present method are appropriate biomarkers responding to retinal photooxidative stress in vivo.

Cytoprotective effects of geranylgeranylacetone against retinal photooxidative damage

Exposure to excessive light induces retinal photoreceptor cell damage, leading to development and progression of various retinal diseases. We tested the effect of geranylgeranylacetone (GGA), an acyclic polyisoprenoid, on light-induced retinal damage in mice. Oral treatment with GGA (1.0 mg/d) for 5 d induced thioredoxin (Trx) and heat shock protein 72 (Hsp72) predominantly in the retinal pigment epithelium (RPE). After white light exposure (8000 lux for 2 h), the percentage of terminal deoxynucleotidyl transferase-mediated biotinylated UTP nick end labeling-positive photoreceptor cells decreased significantly at 24 and 96 h, and the number of photoreceptor cell nuclei at 96 h and the electroretinographic amplitudes of the a- and b-waves at 4 and 10 d increased significantly in GGA-pretreated mice compared with saline-pretreated mice. Light-induced upregulations of 8-hydroxy-2-deoxyguanosine and 4-hydroxy-2-nonenal-modified protein, markers of oxidative stress, were inhibited by GGA pretreatment. To elucidate the cytoprotective mechanism of GGA and Trx, we used human K-1034 RPE cells and mouse photoreceptor-derived 661W cells. In K-1034 cells, GGA (10 microM) induced intracellular Trx, Hsp72, and extracellular Trx but not extracellular Hsp72. Extracellular Trx (0.75 nM) attenuated H2O2 (200 microM)-induced cell damage in 661W cells. Pretreatment with GGA and overexpression of Trx in K-1034 cells counteracted H2O2 (50 microM)-induced attenuation of cellular latex bead incorporation. Protection of phagocytotic activity through induction of Trx and possibly Hsp72 in RPE cells and elimination of oxidative stress in the photoreceptor layer through release of Trx from RPE cells may be mechanisms of GGA-mediated cytoprotection. Therefore, Trx is a neurotrophic factor released from RPE cells and plays a crucial role in maintaining photoreceptor cell integrity.

Study of the effect of involuntary user movement on the potential light hazards from some ophthalmic instruments

A study was undertaken to determine whether involuntary user movement provides a basis for relaxing the measurement conditions for evaluating the potential optical radiation hazards to the eye from slit lamps and indirect ophthalmoscopes. This was accomplished by assessment of the extent to which light from these devices can be maintained in focus on a 1-mm-diameter fiber-optic cable for 45 s. The results suggest that, although involuntary user movements can be significant, they do not provide a basis for relaxing the measurement conditions for evaluating the potential optical radiation hazards to the cornea and lens from slit lamps and indirect ophthalmoscopes.

Comparison of outcomes of primary and secondary implantation of scleral fixated posterior chamber intraocular lens

AIM

To assess and compare the results of primary and secondary implantation of scleral fixated posterior chamber intraocular lens (SFIOL).

METHODS

The medical records of a consecutive series of 55 eyes of 55 patients with SFIOLs implanted during (group 1) or after (group 2) complicated senile cataract surgery were retrospectively reviewed and analysed.

RESULTS

There were 30 and 25 eyes in group 1 and 2, respectively. Follow up was from 6 to 36 months. Mean logMAR postoperative best corrected visual acuity in group 1 was not significantly different (0.50 (SD 0.36)) from that of group 2 (0.36 (0.21)) (p=0.109). Postoperative best corrected visual acuity of 6/12 or better was achieved in 58.6% and 76.0% in group 1 and 2, respectively. The difference was not statistically significant (p=0.177). In group 1, 25 (83.3%) eyes had a total of 55 early complications, while in group 2, 16 (64%) eyes had 26 early complications (p=0.028). The difference in early complication was statistically significant. For late complication after 1 month, 21 (70.0%) eyes had a total of 37 complications in group 1, while 13 eyes (52.0%) had 19 complications in group 2 (p=0.077). The difference in late complication was not statistically significant.

CONCLUSION

Secondary implantation of SFIOL after cataract extraction seems to have a lower early complication rate than primary implantation in complicated cataract extraction although the final visual acuity and late complication rate are not significantly different.

Study of filtered light on potential retinal photic hazards with operation microscopes used for ocular surgery

There have been numerous reports of retinal photic injury from operation microscopes used during cataract surgery. The risk of injury has been associated with the intensity of the light directed into the eye, short-wavelength emission, user technique, exposure time, and direct axial lighting. We evaluated use of light transmission filters to modify a tungsten-halogen light source spectrum to reduce the risk of retinal photic injury. A two-light source filter combination was found with a color profile acceptable for intraocular surgery that reduces the risk of retinal photic injury by a factor of approximately 2.5.

Is scleral fixation a safe procedure for intraocular lens implantation?

PURPOSE

No consensus currently exists on the optimal method for intraocular (IOL) implantation without capsular support. We evaluated the outcome and angiographic findings of eyes that underwent the implantation of scleral fixated IOLs.

METHODS

Iris and retinal fluorescein angiography were performed in 13 eyes that had received posterior chamber IOL implantation with scleral fixation. Follow-up examinations also assessed visual acuity (VA), intraocular pressure (IOP), IOL decentration and complications related to the procedure.

RESULTS

Mean visual acuity was 0.29 preoperatively and 0.71 postoperatively after a mean follow-up of 14.2 months. A best corrected visual acuity of 0.5 or better was obtained in 12 eyes. Iris fluorescein angiography did not show major vascular abnormalities. Retinal angiography showed 5 cases of macular edema. In 6 eyes light-induced retinal lesions occurred. Cellophane maculopathy was disclosed in 4 eyes. Macular edema was associated with photic injury in 4 cases and with cellophane maculopathy in 2 cases. Mean postoperative visual acuity was 0.6 in eyes with macular edema and 0.88 in eyes without (SD 0.18; range 0.5-1.0). Four of 5 eyes with macular edema had a postoperative visual acuity of 0.5 or better. There was no evidence of persistent IOP elevation or IOL decentration. No serious complications were recorded during surgery.

CONCLUSIONS

Transscleral fixation of posterior chamber IOLs provides adequate visual acuity in most patients. Macular edema was frequently associated with the procedure. Although this complication was a cause of low visual recovery after implantation, the majority of eyes with macular edema achieved a visual acuity of 0.5 or better. Light-induced retinal injury was a permanent complication.