Focal choroidal excavation and a traumatic macular hole secondary to accidental Q-switched Nd:YAG laser

Focal choroidal excavation: Review and updated pathogenesis

Focal choroidal excavation is a morphological abnormality that has been recognized with the widespread application of optical coherent tomography. It can exist alone or in combination with or secondary to other chorioretinopathies, so investigators have applied many classification methods, but its pathogenesis is currently not completely understood. We summarize the latest progress in focal choroidal excavation and offer a rethinking of its pathogenesis.

Vitrectomy for a traumatic macular hole caused by cosmetic laser in a beauty salon: A case report

Background

The Nd:YAG laser is widely used in various aspects of work and life. Currently, it has become a popular cosmetic technique in beauty salons. The laser can be dangerous when it flashes into people's eyes.

Case presentation

A 34-year-old female sustained a 1064-nm Q-switched Nd:YAG laser injury to her left eye. One month after the injury, she presented to our clinic with best-corrected visual acuity (BCVA) of 20/250 and a full-thickness macular hole on the optical coherence tomography (OCT). The patient received pars plana vitrectomy, internal limiting membrane peeling and sterile air injection 3 months after the injury. OCT showed closure of the hole 9 days postoperatively. After a 3-month follow-up, her BCVA improved to 20/100.

Conclusions

This case report comprehensively introduces the whole progression of a cosmetic laser-induced macular hole from formation to recovery. Due to the potential threats of the laser and its irreversible damage to the retina and choroid, sufficient education should be given before performing any laser devices, especially those without professional knowledge.

Vitrectomy for laser-induced full-thickness macular hole

Background

To report the structure and visual outcomes of pars plana vitrectomy (PPV) for laser-induced full-thickness macular holes (MHs).

Methods

This retrospective study enrolled 10 patients who underwent vitrectomy for MHs caused by laser injury. Best corrected visual acuity (BCVA), macular spectral-domain optical coherence tomography (OCT) and OCT angiography (OCTA) were used for assessment.

Results

Four patients were injured by unexpected expose of an yttrium aluminum garnet (YAG) laser, and six patients were accidentally injured by a handheld laser. The MH minimum diameters (MDs) ranged from 55 to 966 μm (mean = 548.00 ± 286.10 μm), and BCVA ranged from 20/400 to 20/50 (mean = logMAR 0.87 ± 0.29) preoperatively. All 10 eyes underwent PPV, internal limiting membrane (ILM) peeling, and gas tamponade. All eyes demonstrated closure of the MH with different degrees of discontinuity of the outer layer of the retina, and four eyes exhibited serious retinal pigment epithelium (RPE) destruction. Postoperative BCVA values were significantly improved (mean = logMAR 0.55 ± 0.33; P = 0.032, t = 2.234). The mean BCVA of the destroyed RPE group was significantly worse than that of the non-destroyed RPE group both before and after surgery (P = 0.019; Wilcoxon signed rank test). Further, OCTA indicated choroidal ischemia in the laser-induced MHs.

Conclusion

Vitrectomy can be successful in closing laser-induced full-thickness MHs and improving visual acuity. However, If RPE/choroid is involved in laser damage in addition to the outer retinal layer, this may indicate poor visual prognosis.