Molteno implants and operating microscope-induced retinal phototoxicity. A clinicopathologic report
T. Kramer, R. Brown, M. Lynch, P. Sternberg Jr, G. Buchek, N. L'Hernault and H. E. Grossniklaus
Department of Ophthalmology, Emory University School of Medicine, Atlanta, Ga.
The right eye of a 75-year-old man with a history of cataract extraction,
three penetrating keratoplasties, laser trabeculoplasty, two Molteno
implants, and an operating microscope-induced retinal phototoxic lesion was
studied post mortem. Histopathologic examination of the anterior segment
showed evidence of penetrating keratoplasty, cataract surgery, and two
Molteno implants with minimal associated tissue response. Ultrastructural
examination showed a loose collagenous matrix surrounding the Molteno
reservoirs, suggesting aqueous percolation from the reservoirs into the
conjunctiva. Posteriorly, in the area of the phototoxic operating
microscope-induced lesion, a nodule of retinal pigment epithelial
hyperplasia with overlying atrophy of the photoreceptor cell layer of the
neurosensory retina was noted. The retina also contained cystoid macular
edema and an extensive preretinal membrane that was clinically unexpected.
