Photic retinal injury from endoillumination during vitrectomy.

We treated a patient who developed a paramacular area of light-induced retinal damage after endoscopic epimacular membrane removal. Postoperative color photographs showed complete absence of the membrane, but fluorescein angiography demonstrated a previously absent superior paramacular lesion consistent with a photic injury. Operative microscope illumination had been eliminated by corneal shielding, which implicated endoillumination as the source of injury. We recommend the following procedures to avoid this complication: careful planning of vitreous surgery for epimacular membrane removal; using filters; minimizing the length of surgery; keeping the light output low; maintaining maximal light pipe distance from the retina; eccentric orientation of the light pipe; and use of intermittent and variable site illumination techniques.