ABSTRACT
BACKGROUND: to report on the possible correlation between incident retinal phototoxicity and the use of photosensitizing drugs. METHODS: four patients were examined because of scotomas and visual loss after an incidental exposure to a strong light source. One patient (two eyes) was exposed to standard camera flash; one patient (one eye) had a brief exposure to welding light; one patient (two eyes) underwent uncomplicated phacoemulsifications with intraocular lens implantation. The fourth patient had a severe retinal phototoxicity following a secondary intraocular lens implantation. All four patients underwent a thorough assessment including history of systemic drug use. These patients had ophthalmologic evaluation including: best corrected visual acuity (ETDRS charts), fundus examination, fluorescein and indocyanine green angiographies and were followed for 1 year. RESULTS: on presentation, the mean visual acuity was 7.5/20 (range: 20/400-20/20). Fundus examination disclosed yellow-gray sub-retinal lesions in all affected eyes. Early phase fluorescein angiography showed one or multiple hypofluorescent spots surrounded by a halo of hyperfluorescent window defect. In the late phase, some of these spots leaked the fluorescein dye. Indocyanine green angiography demonstrated hypofluorescent spots throughout with ill-defined borders of hyperfluorescence observed during the late stages. The common finding in these four patients was the fact that they were all taking one or more photosensitizing drugs (hydrochlorothiazide, furosemide, allopurinol, and benzodiazepines). Three of the patients had a full visual recovery a few months after the phototoxicity. The fourth patient remained with a visual acuity of 20/60 12 months after the light exposure. Despite the visual recovery, non-homogeneous retinal pigment epithelial disturbances persisted in all affected eyes. CONCLUSION: phototoxicity following incidental light exposure may occur in patients taking drugs of photosensitizing potential. Therefore, the thorough history of systemic drug ingestion should be obtained if patients have exposure to strong light sources.
Subject(s)
Light/adverse effects , Photosensitizing Agents/administration & dosage , Radiation Injuries/etiology , Retina/radiation effects , Scotoma/etiology , Aged , Allopurinol/administration & dosage , Benzodiazepines/administration & dosage , Female , Fluorescein Angiography , Furosemide/administration & dosage , Humans , Hydrochlorothiazide/administration & dosage , Indocyanine Green , Male , Middle Aged , Radiation Injuries/diagnosis , Retina/drug effects , Retina/pathology , Scotoma/diagnosis , Visual AcuityABSTRACT
Four cases of acute panendothelial retinal leakage in juvenile diabetes are presented. One patient showed acute disc swelling mimicking optic disc new vessels, one had acute cystoid maculopathy, two had both diffuse retinal leakage and optic disc edema. Acute disc swelling and acute cystoid maculopathy in juvenile diabetes are probably variations of the same clinical entity. Acute endothelial leakage can involve either the epipapillary and peripapillary radial capillaries (acute disc swelling), the retinal capillaries of the posterior pole (acute cystoid maculopathy), or the entire epipapillary and retinal capillary network (diffuse panendothelial retinal leakage). Photocoagulation treatment is not indicated in the management of this specific clinical entity. In fact, acute panendothelial retinal leakage in juvenile diabetes seems to be related to poor blood sugar control. In 3 cases the"spontaneous" favorable course of the disease was probably related to the modification of insulin dosage after discovery of the ocular disease.
