Importance of Light Filters in Modern Vitreoretinal Surgery: An Update of the Literature

Abstract

Purpose: Direct endobulbar illumination during vitreoretinal surgery causes light-induced retinal damage known as phototoxicity. Spectral filters have been proposed to eliminate hazardous wavelengths from the emission spectrum before entering the eye. The purpose of our paper is to review advances in vitreoretinal surgery, focusing on intraoperative light filters. Methods: A PubMed and Medline database search was carried out using the terms “spectral filters” associated with “vitreoretinal surgery,” “phototoxicity,” and “vitrectomy.” Original articles, reviews, and book chapters up to March 2017 were reviewed; a few select articles published before 2000 are included for historical purposes. Material from recent meeting presentations was also added. The preferred language for the reviewed literature was English. Results: Spectral filters significantly reduce the risk of phototoxicity associated with endoillumination in vitreoretinal surgery, allowing higher exposure times than with optic light fibers alone. Spectral filters may affect intraoperative luminance, but do not alter color contrast. Amber filters showed superiority over green and yellow filters. Conclusion: The choice of light sources coupled to spectral filters is strongly suggested, especially in dye-assisted chromovitrectomy. Histological donor eye studies and large multicenter trials are needed to validate the amount of photoprotection provided by spectral filters before a general recommendation can be made.

Retinal Pigment Epithelial Irregularity and Atrophy After Internal Membrane Peeling: A Report of Two Cases

“…6 However, we do not encounter retinal phototoxicity commonly in our practices because most surgeons use diffuse illumination and maintain a safe distance from the retina, and special in-built filters also prevent light damage. 10,11 None of our patients were on systemic photosensitizing drugs such as hydrochlorothiazide, furosemide, or allopurinol, which could predispose to phototoxicity. 12…”

Evaluation of the Retinal Hazard With 3d Digitally Assisted Visualization System and Conventional Microscope in Macular Surgeries

“…8,[15][16][17][18] Because the short wavelength visible light contributes to retinal hazard, blue-and ultraviolet-light filters have been equipped in the operating microscopes and endoilluminators to minimize the toxicity during the surgery. 11,19,20 With the introduction of the bandpass filters, the retinal toxicity from the xenon/bandpass light was shown to be comparable with that of the halogen light, although the maximal total luminous flux of the xenon/bandpass light emitted through the 20-gauge endoilluminator was 2.8 times higher than that of the halogen light. 12 However, it should be noted that visible retinal damage was experimentally determined in less than 7.5 minutes with the coaxial operating microscope illumination in pseudophakic monkeys.…”

Effect of Phacoemulsification on Outcomes after Vitrectomy with Membrane Peeling regarding New Intraretinal Cystoid Changes and Transient Macular Edema

“…Ham et al demonstrated in aphakic rhesus monkeys an increased risk of phototoxicity after UV/blue light exposure [47]. Filters eliminating potentially dangerous wavelengths are strongly suggested as they reduce the risk of phototoxicity of endoillumination and therefore allow higher exposure times of endoillumination, and they are even able to enhance contrast in chromovitrectomy [48].…”