Light exposure from microscope versus intracameral illumination during cataract surgery

Kim, Yu Jeong; Nam, Dong Heun; Kim, Young Jae; Kim, Kwang Gi; Kim, Seong-Woo; Chung, Tae Young; Lee, Sung‐Jin; Park, Kyu Hyung

doi:10.4103/ijo.ijo_316_19

Cited by 14 publications

(8 citation statements)

References 13 publications

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“…Although minimizing light exposures and density during ophthalmic surgical procedures may be necessary, making a clinical judgment by practitioners between the risk of brighter light and the consequence of insufficient light is more important [ 129 ]. Using intracameral illumination rather than the microscope illumination during cataract surgery can reduce light exposure reaching a patient's retina [ 131 ].…”

Section: Complicationsmentioning

confidence: 99%

A Review of Complicated Cataract in Retinitis Pigmentosa: Pathogenesis and Cataract Surgery

Hong

Sun

et al. 2020

Journal of Ophthalmology

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Retinitis pigmentosa (RP) is a set of inherited retinal degenerative diseases that affect photoreceptor and retinal pigment epithelial cells (RPEs), possibly associated with some ocular complications, including cataract. The complicated cataract formation is most likely the result of RP-related inflammation response, and the most common morphology category is posterior subcapsular cataract (PSC). Despite the absence of curative pharmacologic treatment, phacoemulsification with intraocular lens implantation to deal with opacification in the lens is preferred due to the considerable visual outcomes. However, the incidence of intraocular and postoperative complications is higher in RP patients than those without, including intraoperative phototoxic retinal damage, posterior capsular opacification (PCO), capsular contraction syndrome (CCS), pseudophakic cystoid macular edema (PCME), increased postoperative intraocular pressure (IOP), and intraocular lens (IOL) dislocation. Hence, it needs much attention to surgery progress and close follow-up. In this review, we discuss the current understanding of RP patients with complicated cataracts from morphology to potential pathogenesis to cataract surgical procedure and provide a concise description and the recommended management of related surgery complications to broaden the knowledge and lower the latent risks to yield better clinical outcomes.

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Section: Complicationsmentioning

confidence: 99%

A Review of Complicated Cataract in Retinitis Pigmentosa: Pathogenesis and Cataract Surgery

Hong

Sun

et al. 2020

Journal of Ophthalmology

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“…This case highlights the importance of recognizing the potential occupational hazard of light microscope use, in which light is directed towards the user's eyes. To a lesser extent, this also applies to light exposure by users of the operating microscope in ophthalmic microsurgery [1]. Further studies are required to determine the safe levels of luminous flux and the maximum exposure time required for visual symptoms or changes on imaging to develop, in order to provide recommendations to limit this occupational hazard.…”

Section: Resultsmentioning

confidence: 99%

“…Light microscope use is known to expose the user to significant retinal light irradiance [1]. Photochemical injury affects the outer retina and retinal pigment epithelium, probably via oxidative stress and a temperature rise, and short wavelength radiation in the visible and ultraviolet electromagnetic spectrum may have a role in the pathogenesis of macular diseases such as age-related macular degeneration [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Retinal Lesions Diagnosed After Light Microscope Use with Outer Segment Hyper-Reflective Changes on Optical Coherence Tomography: A Case Report

Vassallo

Ceci

2020

SN Compr. Clin. Med.

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This is a brief report of possibly the first documented case of retinal phototoxicity secondary to occupational use of the light microscope with visible optical coherence tomography (OCT) changes. A 30-year-old hospital pathologist presented with a unilateral central scotoma after increased use of the light microscope. OCT of the macula at presentation and after 8 months demonstrated focal outer segment hyper-reflective spots at the centre of the fovea. There were no visible changes on fundoscopy and blue-light autofluorescence imaging. The symptoms resolved after advising the patient to limit the brightness and duration of light microscope use. The hazards of using the light microscope should be recognized, and light exposure and brightness minimized. OCT can help detect objective changes when the fundus looks normal on examination.

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“…They concluded that the microscope ocular illuminance and irradiance during cataract surgery were higher in the microscope illumination than in the intracameral illumination. It suggests that light exposure reaching the patient's and surgeon's retina during cataract surgery is lower in the intracameral illumination than in the microscope illumination [ 27 ]. A similar work with the same conclusion was also published by Seo et al The authors summarized that, in view of the patients' visual experience, oblique intracameral illumination caused less subjective photostress and was preferred over coaxial microscope illumination [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Use of Simultaneous Bilateral Cataract Surgery (SBCS) to Optimize Parameters Affecting the Subjective Perception of the Procedure

Studený

Vranová

Nováček

2021

Journal of Ophthalmology

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Introduction. Simultaneous Bilateral Cataract Surgery (SBCS) is still a relatively controversial procedure. The main objection is the risk of bilateral endophthalmitis or bilateral refractive error. However, SBCS has also some advantages (faster visual rehabilitation, lower risk of nosocomial infection, and lower cost). Performing surgery on both eyes in one session has one additional advantage which has not yet been described in the literature (according to the information available to authors). It allows surgeons to distinguish the effect of minor differences in the surgical protocol on the subjective perception of the procedure more accurately, which is a more suitable method than comparing two independent groups of patients. Purpose. To compare the effect of minor changes in the surgical protocol during SBCS on intraindividual subjective perception of surgery (pain, pressure, glare, and perception of the duration of the surgery). Methods. During the surgery of the right and left eyes of one patient, we randomly changed one surgical parameter (use of intracameral anesthesia, light intensity of the operating microscope, type of eyelid speculum, creation of the posterior circular capsulorhexis, and communication with the patient during surgery). Patients immediately after both surgeries subjectively evaluated the perception of pain (on the scale 0–10), pressure, and glare (on the scale 0–5) and estimated the duration of the surgery, separately for each eye. Each change was evaluated in a group of 50 patients. Results. In the control group with no parameters changed, we noted no difference in subjective perception of the first and second surgery. In subgroups, where we changed the protocol, we detected only minor differences in subjective perception of pain, pressure, glare, and duration of the surgery. Only one statistically significant difference in subjective pain perception was in the subgroup where we used eye intracameral anesthesia (0.34 eyes with intracameral anesthesia, 0.44 eyes with only topical anesthesia). We did not note any statistically significant differences in the perception of the time of surgery. Conclusion. SBCS can be used to optimize the parameters of cataract surgery. In our study, we noted a positive effect of intracameral anesthesia on subjective perception of surgery.

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Light exposure from microscope versus intracameral illumination during cataract surgery

Cited by 14 publications

References 13 publications

A Review of Complicated Cataract in Retinitis Pigmentosa: Pathogenesis and Cataract Surgery

A Review of Complicated Cataract in Retinitis Pigmentosa: Pathogenesis and Cataract Surgery

Retinal Lesions Diagnosed After Light Microscope Use with Outer Segment Hyper-Reflective Changes on Optical Coherence Tomography: A Case Report

Use of Simultaneous Bilateral Cataract Surgery (SBCS) to Optimize Parameters Affecting the Subjective Perception of the Procedure

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