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Letter
Phototoxic maculopathy following uneventful cataract surgery in a predisposed patient
  1. B Manzouri,
  2. C A Egan,
  3. P G Hykin
  1. Medical Retina Service, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK
  1. Correspondence to: Mr P G Hykin; phil.hykin{at}moorfields.nhs.uk

https://doi.org/10.1136/bjo.86.6.705

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    Operating microscope light induced foveal damage is a well recognised occurrence following ocular surgery including complicated cataract extraction, complex anterior segment procedures, and vitrectomy surgery.1 An increased risk of phototoxicity is associated with an operating time greater than 100 minutes, increased body and therefore retinal temperature, unfiltered blue light, and hyperoxaemia.2,3

    We report a patient who developed a phototoxic lesion during routine cataract surgery possibly related to underlying systemic lupus erythematosus (SLE) and hydroxychloroquine treatment. We examine the measures taken to prevent recurrence with second eye surgery and the implications for routine cataract surgery are discussed.

    Case report

    A 39 year old woman presented with blurred left vision and glare. One year previously she had been diagnosed with SLE for which she had been taking hydroxychloroquine 200 mg and prednisolone 5 mg daily for 18 months. She had bilateral subcapsular cataracts and underwent routine left phacoemulsification and lens implant surgery under general anaesthesia.

    Directly after surgery, the patient noted two confluent blind spots immediately below fixation in the left eye. When first seen by us the left visual acuity was 6/5, intraocular pressure was 16 mm Hg, and the eye was quiet with a well centred posterior chamber lens …

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