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Eric A. Postel, MD; Jose S. Pulido, MD, MS; Gordon A. Byrnes, MD; Jeffrey Heier, MD; William Waterhouse, MD; Dennis P. Han, MD; William F. Mieler, MD; Claire Guse, MS; Walt Wipplinger

Arch Ophthalmol. 1998;116:753-757.

Objective  To evaluate the outcomes of a group of patients who suffered iatrogenic phototoxic injury.

Methods  The medical records of 24 patients (24 eyes)with iatrogenic phototoxicity from 3 medical centers were reviewed. We report the findings from long-term follow-up of these patients with particular attention to visual outcome, type and duration of procedure, and location of the phototoxic lesion.

Results  Phototoxic injury occurred after anterior segment surgery in 20 eyes and after vitrectomy in 4 eyes. The mean duration of surgery was 109 minutes; there was no statistically significant difference in duration between the anterior segment procedures and the vitrectomies. Mean final visual acuity was 20/40 for all cases (range, 20/15 to counting fingers) and 20/25 for all anterior segment cases. In vitrectomized eyes, the mean final visual acuity was 20/900. Phototoxic lesions tended to spare the fovea after anterior segment surgery and involve the foveal center after vitrectomy.

Conclusions  In general, patients who suffer phototoxicity do well, and the prognosis is good for extrafoveal lesions. Foveal injury, which often occurs with vitrectomy, usually leads to a worse visual outcome. The development of choroidal neovascularization may have an effect on the ultimate visual outcome as well.

From Duke University Medical Center (Dr Postel), the Eye Institute (Drs Pulido, Han, and Mieler and Mr Wipplinger) and the Department of Family and Community Medicine (Ms Guse), Medical College of Wisconsin, Milwaukee; Department of Ophthalmology, National Naval Medical Center, Bethesda, Md (Dr Byrnes); and Retino-vitreous Associates, Fort Wayne, Ind (Dr Heier).

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