Retinal Phototoxicity after pars plana vitrectomy in a patient under Pre-Exposure Prophylaxis (PrEP) for HIV...

To present a case of suspected retinal phototoxicity after pars plana vitrectomy in a 45-year-old man undergoing Pre-Exposure Prophylaxis (PrEP) for HIV prevention.

Retrospective case report. A 25-gauge pars plana vitrectomy was performed for vitreous hemorrhage and retinal breaks. Standard endo-illumination settings were used. No vital dyes were applied. Despite an initial uneventful surgery, a secondary retinal detachment required a subsequent vitrectomy with gas tamponade. Optical coherence tomography (OCT) and blue fundus autofluorescence were performed at each follow-up visit.

Postoperatively, OCT and blue fundus autofluorescence disclosed parafoveal disruption of the outer retinal layers, focal ellipsoid zone discontinuities, and retinal pigment epithelium (RPE) mottling within the illuminated area. At six months, best-corrected visual acuity improved to 20/25, although persistent RPE alterations were evident.

The pattern of outer retinal changes suggests a photochemical injury potentiated by photosensitization from PrEP medication. Our findings underscore the need for new strategies to reduce light exposure during surgery in patients on systemic photosensitizing agents.