Lightless cataract surgery using a near-infrared operating microscope

Kim, Bong-Hyun

doi:10.1016/j.jcrs.2006.05.024

Cited by 9 publications

(2 citation statements)

References 26 publications

(26 reference statements)

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“…The author's purpose was to prevent light-associated complications of cataract surgery (ie, photochemical retinal damage). 22 That system could be equally applicable for surgical manipulations in patients with retinal diseases that would render them susceptible to light damage.…”

Section: Commentmentioning

confidence: 99%

Operating in the Dark

2008

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A standard operating microscope was modified with a bandpass infrared filter in the light path and infrared image intensifiers for each of the 2 eyepieces. We evaluated this system for subretinal injections in normal control dogs and those with a mutation in the rhodopsin gene. Rhodopsin-mutant dogs are a model for human autosomal dominant retinitis pigmentosa, and their retinas degenerate faster when exposed to modest light levels as used in routine clinical examinations. We showed that the mutant retinas developed severe generalized degeneration when exposed to the standard operating microscope light but not the infrared light. The modified operating microscope provided an excellent view of the ocular fundus under infrared illumination and allowed us to perform subretinal injections in the retinas of the rhodopsin-mutant dogs without any subsequent light-induced retinal degeneration.The first description of light-induced retinal damage showed that exposure of albino rats to visible light intensities ordinarily encountered in the laboratory led to irreversible retinal damage. 1 This finding soon was extended to other species, including rabbits 2 and monkeys. 3 Studies in animal models of retinal degeneration (eg, Royal College of Surgeons rats, ABCA4-mutant mice, or rhodopsin-mutant mice and dogs) have emphasized the interplay between the gene mutation and environmental light and demonstrated acceleration of the disease process by light. [4][5][6][7][8][9][10] The effect of environmental light on disease severity in humans with retinitis pigmentosa has been suggested by case reports, 11 although definitive proof is lacking. However, patients with class B1 rhodopsin mutations may be at risk of accelerated vision loss with increased light exposures because they have defects in dark (bleaching) adaptation similar to those found in rhodopsinmutant dogs that demonstrate a high susceptibility to retinal light damage. 8,12,13 Many of the emerging therapies for retinal degeneration require the intraocular placement of a reagent or device with the use of an operating microscope. 14,15 The damaging effect of the microscope light on the normal retina, even with the appropriate filtering of UV light, has been described previously, 16,17 and there is increased emphasis on reducing the intensity and duration of the exposures. Herein, we describe a modification of an operating microscope with an infrared bandpass filter and a night-vision system to perform surgical interventions in the posterior segment of the eyes of rhodopsin-mutant dogs without the risk of photochemical retinal damage. This modification prevents acceleration of the photoreceptor degeneration that occurs with exposure to modest light levels as used in routine clinical practice. 8 If humans with retinitis pigmentosa are shown to have similar light damage susceptibility, this microscope modification could be considered for surgical procedures such as the subretinal application of gene therapy vectors.

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Section: Commentmentioning

confidence: 99%

Operating in the Dark

2008

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“…In view of maximizing operational safety, which calls for sufficient red reflex during cataract surgery, nonetheless, these modifications cannot be considered routine. [34]…”

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confidence: 99%

Light exposure from microscope versus intracameral illumination during cataract surgery

Kim

Nam

Kim

et al. 2019

Indian J Ophthalmol

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Purpose:To evaluate light exposure from microscope versus intracameral illuminations to patient's and surgeon's retina during cataract surgery.Methods:Thirty consecutive patients who had cataract surgery using microscope and intracameral illuminations. At the point of the ocular of an operating microscope, optical illuminance and irradiance from the microscope illumination (60, 40, 20% intensity) and the intracameral illumination (60% intensity) were measured using a light meter and a spectrometer at a pause after lens capsule polishing in cataract surgery.Results:Average illuminance (lux) was 1.46, 0.66, 0.27, and 0.1 from 60%, 40%, 20% intensity microscope illuminations and 60% intracameral illumination. Average total spectral irradiance (μW/cm2) was 1.25, 0.65, 0.26, and 0.03 from 60%, 40%, 20% intensity microscope illuminations and 60% intracameral illumination.Conclusion: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 patient's and surgeon's retina during cataract surgery is lower in the intracameral illumination than in the microscope illumination.

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