ABSTRACT
We report a case of combined brilliant blue G and endoilluminator retinal toxicity in a patient who has undergone macular hole surgery. The patient developed extensive degeneration of the retinal pigment epithelium as early as 1 week following surgery that eventually lead to poor visual outcome. We look into the pathogenesis of BBG and endoilluminator causing retinal toxicity and also suggest measures to avoid this irreversible retinal damage.
ABSTRACT
Abstract The high irradiance and the different emission spectra from contemporary light curing units (LCU) may cause ocular damage. This study evaluated the ability of 15 eye protection filters: 2 glasses, 1 paddle design, and 12 dedicated filters to block out harmful light from a monowave (HP-3M ESPE) and a broad-spectrum (Valo, Ultradent) LED LCU. Using the anterior sensor in the MARC-Patient Simulator (BlueLight Analytics) the irradiance that was delivered through different eye protection filters was measured three times. The LCUs delivered a similar irradiance to the top of the filter. The mean values of the light that passed through the filters as percent of the original irradiance were analyzed using two-way ANOVA followed by Tukey test (a= 0.05). The emission spectra from the LCUs and through the filters were also obtained. Two-way ANOVA showed that the interaction between protective filters and LCUs significantly influenced the amount of light transmitted (p< 0.001). Tukey test showed that the amount of light transmitted through the protective filters when using the HP-3M-ESPE was significantly greater compared to when using the Valo, irrespective of the protective filter tested. When using the HP-3M-ESPE, the Glasses filter allowed significantly more light through, followed by XL 3000, ORTUS, Google Professional, Gnatus filters. The Valo filter was the most effective at blocking out the harmful light. Some protective filters were less effective at blocking the lower wavelengths of light (<420 nm). However, even in the worst scenario, the filters were able to block at least 97% of the irradiance.
Resumo A alta irradiância e diferentes espectros de luz emitidos por aparelhos fotopolimerizadores (Fp) podem causar danos oculares. Este estudo avaliou a capacidade de 15 filtros de proteção ocular em bloquear a luz prejudicial de um Fp convencional (HP-3M ESPE) e outro de largo espectro (Valo, Ultradent). Utilizando sensor anterior do equioamento MARC-Patient Simulator (BlueLight Analytics inc.) a irradiância que passou através dos diferentes filtros protetores foi mensuradas três vezes. Os valores médios da irradiância que passaram pelos filtros foram analisados usando Análise de variância fatorial e pelo teste de Tukey (a= 0.05). O espetro emitido dos Fps através dos filtros também foi obtido. A análise de variância mostrou que a interação entre os filtros protetores e Fps influenciou significantemente a quantidade de luz transmitida (p<0,001). O teste de Tukey mostrou que a quantidade que luz transmitida através dos protetores oculares quando usado o HP-3M ESPE foi significantemente maior quando comparado aos valores para o Valo, independentemente do filtro testado. Quando foi utilizado a fonte de luz HP-3M ESPE, o filtro de proteção ocular permitiu significativamente maior passagem de luz, seguido por XL 3000, ORTUS, Google Professional, e pelo filtro Gnatus. O filtro do Valo foi o mais eficiente ao bloquear a luz prejudicial. Alguns filtros foram menos eficazes ao bloquear menores comprimentos de onde (<420 nm). No entanto, mesmo no pior cenário dos resultados deste estudo, os filtros foram capazes de bloquear ao menos 97% da irradiância emitida pelas fontes de luz testadas.
Subject(s)
Humans , Curing Lights, Dental/adverse effects , Eye Protective Devices/standards , Analysis of Variance , Optics and PhotonicsABSTRACT
Objetivo: determinar la utilidad de la microperimetría y la tomografía óptica coherente en la detección de daño retinal subclínico por cloroquina. Métodos: estudio prospectivo, observacional y analítico en pacientes consumidores de cloroquina, atendidos en la consulta de Neuroftalmología del Instituto Cubano de Oftalmología Ramón Pando Ferrer, entre septiembre 2010 y octubre 2011. Fueron incluidos 44 ojos. Se realizaron exámenes para evaluar función (psicofísica visual y microperimetría) y estructura (biomicroscopia y tomografía óptica coherente). Resultados: la edad promedio fue de 43 años con una dosis acumulada de cloroquina de 182 g y un tiempo de consumo inferior a cinco años. Existió relación significativa entre la dosis acumulada y las variables siguientes: visión del color (-0,495; p= 0,001), grosor retinal peripapilar temporal (-0,353; p= 0,019) e inferior (-0,336; p= 0,026), macular central (-0,652; p= 0,000) y sensibilidad retinal por microperimetría (-0,436; p= 0,003) con alteraciones funcionales y estructurales en relación con el incremento de la dosis acumulada. Conclusiones: se demostró que es posible detectar daño retinal funcional temprano mediante microperimetría y tomografía óptica coherente en pacientes consumidores de cloroquina, en presencia de otros estudios funcionales y biomicroscopia normales. Unido a la tomografía óptica coherente el microperímetro puede constituir una útil herramienta para pesquisa de toxicidad retiniana
Objective: to determine the usefulness of microperimetry and of the optical coherence tomography in the detection of subclinical retinal damage due to chloroquine. Methods: prospective, observational and analytical study in patients taking chloroquine, who were seen at the Neuro-ophthalmology service of "Ramón Pando Ferrer" Institute of Ophthalmology from September 2010 through October 2011. Forty four eyes were included. Tests were performed to assess function (visual psychophysics and microperimetry) and structure (biomicroscopy and optical coherence tomography). Results: mean age was 43 years with a cumulative dose of 182 g and less than 5 years taking this drug. There was significant correlation between the cumulative dose of chloroquine and the following variables: color vision (-0.495, p = 0.001), temporal peripapillary retinal thickness (-0.353, p= 0.019) and lower (-0.336, p = 0.026), central macular (-0.652, p = 0.000) and retinal sensitivity by microperimetry (-0.436, p= 0.003) with functional and structural changes related to the increase in cumulative dose. Conclusions: it was demonstrated that it is possible to detect early functional retinal damage by using microperimetry and optical coherence tomography in patients taking chloroquine, despite normal results of other functional studies and of biomicroscopy. The combination of microperimetry and optical coherence tomography may be a useful screening tool for retinal toxicity
Subject(s)
Humans , Male , Female , Chloroquine/adverse effects , Retinal Perforations/diagnosis , Retinal Perforations/chemically induced , Visual Field Tests/methods , Tomography, Optical/methods , Observational Studies as Topic , Prospective StudiesABSTRACT
Background Light-induced retinal damage models vary as many influence factors,herein the modeling method is difficult to copy.It is necessary to establish the grading standardization of retinal damage after retinal light exposure.Objective This study was to improve the modeling method and establish a grading standardization for light-induced retinal damage in rat.Methods Twenty-four SPF 8-10 week-old male SD rats were randomly divided into 4 groups and 6 eyes for each group.The rats were exposed to light intense of 5000 lx for 1,2,3 hours respectively in 3 groups,and other 6 rats served as the normal group.Full-field light exposure experiment was performed for each individual rat separately,and an annular illumination box was used tO ensure the experimental rat moving in a single direction and exposing the right eye in 5000 lx light surrounding during experimental duration.Ganzfeid electroretinogram(ERG)was recorded from the experimental rats at the fifth day after light exposure,and the animals were then sacrificed for histopathology observation to evaluate the retinal thickness change.All procedures which involved animals adhered to the ARVO Statement for the Use of Animals in Ophthalmic and Vision Research.Results After exposing to intensity light for 1,2,3 hours,the b-wave amplitudes of rod response,maximal mixed response,oscillatory potential in scotopic ERG as well as cone response,20 Hz flicker response of photopic ERG were significant declined as lapse of light exposure time(F=71.690,P=0.000；F=56.250,P=0.000；F=23.610,P=0.000：F=27.130,P=0.000；F=27.030,P=0.000)and lowed by 26.2％,52.5％,70.7％,24.4％,39.3％,58.1％respectively at the end of experiment.Meanwhile,the b-wave latencies of rod response,maximal mixed response in scotopic ERG as well as cone response of photopic ERG were evidently different among different groups (F=1.370,P=0.282；F：0.800,P=0.508；F=11.840,P=0.000；F=2.080,P=0.136).Light induced retinal damage located mainly at the temporal retina area.After intensity light exposure for 1,2,3 hours,the thickness of outer nuclear layer at the superior temporal retina attenuated by 11.3％,25.6％and 72.5％,respectively(P<0.05).A significant difference was seen in mean thickness of outer nuclear layer at superior temporal retina among different groups(F=410.27,P=0.000). Conclusion A standardized grading method for light-induced retinal damage is recommended.The continuous illumination in a intensity of 5000 Ix for 1,2,3 hours can induce the mild,moderate or severe retinal damage respectively at temporal retina.