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.

1.
Machemer R: The development of pars plana vitrectomy: a personal account. Graefes Arch Clin Exp Ophthalmol 1995;233:453-468.
2.
de Oliveira PR, Berger AR, Chow DR: Vitreoretinal instruments: vitrectomy cutters, endoillumination and wide-angle viewing systems. Int J Retina Vitreous 2016;5;2:28.
3.
Glickman RD: Phototoxicity to the retina: mechanisms of damage. Int J Toxicol 2002;21:473-490.
4.
Azzolini C, Brancato R, Venturi G, et al: Updating on intra-operative light-induced retinal injury. Int Ophthalmol 1994;18:269-276.
5.
Charles S: Illumination and phototoxicity issues in vitreoretinal surgery. Retina 2008;28:1-4.
6.
Parmar T, Parmar VM, Arai E, et al: Acute stress responses are early molecular events of retinal degeneration in Abca4-/- Rdh8-/- mice after light exposure. Invest Ophthalmol Vis Sci 2016;57:3257-3267.
7.
van den Biesen PR, Berenschot T, Verdaasdonk RM, van Weelden H, van Norren D: Endoillumination during vitrectomy and phototoxicity thresholds. Br J Ophthalmol 2000;84:1372-1375.
8.
Chow DR: The evolution of endoillumination. Dev Ophthalmol 2014;54:77-86.
9.
International Standards Organization. Ophthalmic Instruments - Fundamental Requirements and Test Methods. Part 2: Light Hazard Protection. ISO 15004-2. Geneva, International Organization for Standardization, 2007.
10.
Ham WT Jr, Mueller HA, Ruffolo JJ Jr, Guerry D 3rd, Guerry RK: Action spectrum for retinal injury from near-ultraviolet radiation in the aphakic monkey. Am J Ophthalmol 1982;93:299-306.
11.
Landry RJ, Bostrom RG, Miller SA, Shi D, Sliney DH: Retinal phototoxicity: a review of standard methodology for evaluating retinal optical radiation hazards. Health Phys 2011;100:417-434.
12.
Farah ME, Maia M, Penha FM, Rodrigues EB: The use of vital dyes during vitreoretinal surgery - chromovitrectomy. Dev Ophthalmol 2016;55:365-375.
13.
Rodrigues EB, Meyer CH, Farah ME, Kroll P: Intravitreal staining of the internal limiting membrane using indocyanine green in the treatment of macular holes. Ophthalmologica 2005;219:251-262.
14.
Haritoglou C, Gandorfer A, Gass CA, Schaumberger M, Ulbig MW, Kampik A: Indocyanine green-assisted peeling of the internal limiting membrane in macular hole surgery affects visual outcome: a clinicopathologic correlation. Am J Ophthalmol 2002;134:836-841.
15.
Farah ME, Maia M, Rodrigues EB: Dyes in ocular surgery: principles for use in chromovitrectomy. Am J Ophthalmol 2009;148:332-340.
16.
Haritoglou C, Priglinger S, Gandorfer A, Welge-Lussen U, Kampik A: Histology of the vitreoretinal interface after indocyanine green staining of the ILM, with illumination using a halogen and xenon light source. Invest Ophthalmol Vis Sci 2005;46:1468-1472.
17.
Oshima Y, Chow DR, Awh CC, Sakaguchi H, Tano Y: Novel mercury vapor illuminator combined with a 27/29-gauge chandelier light fiber for vitreous surgery. Retina 2008;28:171-173.
18.
Adam MK, Thornton S, Regillo CD, Park C, Ho AC, Hsu J: Minimal endoillumination levels and display luminous emittance during three-dimensional heads-up vitreoretinal surgery. Retina 2016, Epub ahead of print.
19.
Eckardt C, Paulo EB: Heads-up surgery for vitreoretinal procedures: an experimental and clinical study. Retina 2016;36:137-147.
20.
Meyers SM, Bonner RF: Yellow filter to decrease the risk of light damage to the retina during vitrectomy. Am J Ophthalmol 1982;94:677.
21.
Chow D: The effect of light source filters on tissue visualization: a multicenter trial. Euretina 13th Congress; September 2013; Hamburg.
22.
Kraushar MF, Harris MJ, Morse PH: Monochromatic endoillumination for epimacular membrane surgery. Ophthalmic Surg 1989;20:508-510.
23.
Enaida H, Hachisuka Y, Yoshinaga Y, Ikeda Y, Hisatomi T, Yoshida S, Oshima Y, Kadonosono K, Ishibashi T: Development and preclinical evaluation of a new viewing filter system to control reflection and enhance dye staining during vitrectomy. Graefes Arch Clin Exp Ophthalmol 2013;251:441-451.
24.
Henrich PB, Valmaggia C, Lang C, Cattin PC: The price for reduced light toxicity: Do endoilluminator spectral filters decrease color contrast during brilliant blue G-assisted chromovitrectomy? Graefes Arch Clin Exp Ophthalmol 2014;252:367-374.
25.
Coppola M, Lizzano M, Marchi S: Amber filter vs. conventional xenon light source for 23 gauge pars plana vitrectomy in epiretinal membrane: OCT and Autofluorescence findings. ARVO Meeting 2013. Invest Ophthalmol Vis Sci 2013;54:3300.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.