Retinal Phototoxicity Caused by Chandelier Endoillumination

Abstract

 

Purpose:

 

Retinal phototoxicity has been well described as a complication of fiberoptic endoillumination during vitreoretinal surgery. However, it has not been previously reported in the literature as a complication of chandelier illumination, which is becoming increasingly utilized during retinal surgery. We describe two cases of phototoxicity resulting from chandelier illumination during vitrectomy.

 

Methods:

 

Small Case Series. We retrospectively reviewed the charts, clinical history, and outcomes of our two cases.

 

Results:

 

Two cases are reported. In both cases, pars plana vitrectomy for retinal detachment was performed using dual fiber 27 gauge chandelier illuminators at 50% power. During air fluid exchange, illumination quality degraded significantly, and an irregularly shaped light beam was noted. The probe tips were noted to be distorted at the conclusion of both cases. Within 10 days, both patients developed evidence of photoxicity demonstrated by clinical examination as well as autofluorescence images (see figure).

 

Conclusions:

 

Phototoxicity developed shortly after vitrectomy utilizing chandelier illumination in two retinal detachment cases. Based on the change in visualization during the air-fluid exchange, we hypothesize that the probe tip melted, a complication that has been theorized to be possible in prior reports. We hypothesize that a change in shape of the melted tip resulted in a more focused beam on the retinal surface. While direct thermal injury has been recently characterized by Shimada, to our knowledge this is the first report of photoxicity occurring from chandelier endoillumination. This is an important complication of chandelier illumination that should be recognized by all vitreoretinal surgeons.  

 

Keywords: retina • vitreoretinal surgery