Incidental retinal phototoxicity associated with ingestion of photosensitizing drugs.
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.


CONCLUSIONS
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.
Mauget-Faÿsse
M
M
Centre d'Imagerie-Laser Rabelais, Lyon, France. Dr.M.MAUGET-FAYSSE@wanadoo.fr
Quaranta
M
M
Francoz
N
N
BenEzra
D
D
Mauget-Fa
M
M
D000368:Aged; D000493:Allopurinol / Q000008:administration & dosage; D001569:Benzodiazepines / Q000008:administration & dosage; D005260:Female; D005451:Fluorescein Angiography; D005665:Furosemide / Q000008:administration & dosage; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage; D007208:Indocyanine Green; D008027:Light / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017319:Photosensitizing Agents / Q000008:administration & dosage*; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology*; D012160:Retina / Q000187:drug effects / Q000473:pathology / Q000528:radiation effects*; D012607:Scotoma / Q000175:diagnosis / Q000209:etiology*; D014792:Visual Acuity
D017319:Photosensitizing Agents; D006852:Hydrochlorothiazide; D001569:Benzodiazepines; D000493:Allopurinol; D005665:Furosemide; D007208:Indocyanine Green