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Mishra AV, Grewal PS. Laser pointer-induced maculopathy with secondary macular neovascularization. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e177. [PMID: 38006901 DOI: 10.1016/j.jcjo.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/04/2023] [Accepted: 10/28/2023] [Indexed: 11/27/2023]
Affiliation(s)
- Amit V Mishra
- Alberta Retina Consultants, Edmonton, AB; University of Alberta, Edmonton, AB
| | - Parampal S Grewal
- Alberta Retina Consultants, Edmonton, AB; University of Alberta, Edmonton, AB..
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Keshet Y, Weseley PE, Ceisler EJ, Ngo WK, Salcedo A, Walia J, Spaide RF. THE EVOLUTION Of FULL-THICKNESS MACULAR HOLE AFTER SHORT EXPOSURE TO HIGH-POWERED HANDHELD LASER POINTER. Retin Cases Brief Rep 2024; 18:177-180. [PMID: 36730459 DOI: 10.1097/icb.0000000000001374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To report a case of a full-thickness macular hole after exposure to an extremely powerful handheld laser pointer. METHODS A 14-year-old boy with a laser-induced full-thickness macular hole was evaluated 1 month after a momentary exposure to a 5,000 mW blue laser pointer. Imaging modalities including fundus color, autofluorescence, and spectral-domain optical coherence tomography, acquired both at our clinic and by the referring physician soon after the injury, are used to describe the clinical evolution of the case. RESULTS Soon after the injury, an intensely white, circular opacification of the retina approximately 400 μm in diameter was seen in the fovea. Early spectral-domain optical coherence tomography images showed full-thickness hyperreflectivity, likely representing tissue necrosis. One month later, a full-thickness macular hole and eradication of the retinal pigment epithelium at its base were evident in the fundus color, autofluorescence, and spectral-domain optical coherence tomography images. CONCLUSION High-power laser pointers have become easily available online. The presenting findings after exposure to such high-power devices are distinct from those reported after exposure to weaker laser pointers. Although long exposure to weaker lasers typically produces extensive, calligraphic figures and yellow placoid lesions involving only the outer retina, in our case, a very brief exposure led to focal full-thickness injury of the fovea.
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Affiliation(s)
- Yariv Keshet
- Vitreous Retina Macula Consultants of New York, New York; and New York University Langone, New York, New York
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Incidence and long-term outcome of laser pointer maculopathy in children. Int Ophthalmol 2023:10.1007/s10792-023-02638-w. [PMID: 36670265 DOI: 10.1007/s10792-023-02638-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/10/2023] [Indexed: 01/21/2023]
Abstract
PURPOSE Single center study to evaluate the incidence and long-term outcome of laser pointer maculopathy (LPM). METHODS Medical records of 909,150 patients visiting our institution between 2007 and 2020 were screened in our electronic patient record system using the keywords "laserpointer," "laser pointer," and "solar." RESULTS Eight patients (6/2 male/female, 11 eyes) with a history of LPM were identified by fundoscopy and optical coherence tomography (OCT), all of whom were children (6/2 male/female). Mean age at injury was 12.1 years (range 6-16). Five children (62.5%) were injured between 2019 and 2020, three (37.5%) between 2007 and 2018. Median best-corrected visual acuity (BCVA) of affected eyes at first presentation was 20/25 (range 20/50-20/16). Follow-up examination was performed in seven children (10 eyes) with a median follow-up period of 18 months (range 0.5-96). BCVA improved in 4 children (5 eyes; BCVA at follow-up 20/22.5, range 20/40-20/16). Three of these four children were treated with oral steroids. OCT revealed acute signs such as intraretinal fluid to resolve quickly, while outer retinal disruption persisted until the last follow-up in eight of eleven eyes. These lesions resembled lesions of patients with solar retinopathy of which seven cases (11 eyes) were identified between 2007 and 2020. CONCLUSION Readily available consumer laser pointers can damage the retina and the underlying retinal pigment epithelium, possibly leading to long-lasting visual impairments. The number of laser pointer injuries has increased over the last years. Therefore, access to laser pointers for children should be strictly controlled.
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Chen Y, Cunningham A, Kotagiri A. The Danger of Laser Pointer-Induced Retinal Damage in Children: A Large United Kingdom Case Series and Survey of Public Awareness. J Pediatr Ophthalmol Strabismus 2023; 60:52-59. [PMID: 35611824 DOI: 10.3928/01913913-20220425-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To explore the clinical features of laser pointer-related retinal injuries among children and gain insight into the general public awareness around laser pointer use. METHODS This was a retrospective case series of 9 children (12 eyes) with laser pointer-related retinal injury from a United Kingdom tertiary ophthalmology unit and a prospective survey of laser pointer use and awareness among children and parents presenting to the hospital eye service for other eye conditions. RESULTS Within the case series, 67% of patients were asymptomatic on presentation. A mean follow-up of 25.6 months showed that structural changes persisted in all cases, and in one case, there was progression in the macular lesion size. One case presented with secondary choroidal neovascular membrane, requiring intravitreal anti-vascular endothelial growth factor injections. A survey showed that 9% of children admitted to having played with laser pointers and 13% of parents were aware of their children playing with laser pointers. Only one-third of children and parents were aware of laws regulating laser pointers. Most parents (96%) agreed that there needs to be increased awareness regarding laser pointers' effect on vision. CONCLUSIONS This study has highlighted that although children may be asymptomatic at presentation, there is usually permanent structural damage to the macula, and complications such as secondary choroidal neovascular membrane can develop years later. The survey found a relatively high incidence of laser pointer use with little awareness of the regulation laws. There is an urgent need to establish more robust measures to improve public awareness and regulations around laser pointers. [J Pediatr Ophthalmol Strabismus. 2023;60(1):52-59.].
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Narayanan R, Tyagi M, Sahoo NK, Reddy S, Pathengay A. Accidental Self-Inflicted Handheld Laser-Induced Maculopathy. Ocul Immunol Inflamm 2023; 31:211-214. [PMID: 34637668 DOI: 10.1080/09273948.2021.1988987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To report a case of accidental self-inflicted handheld Laser-Induced Maculopathy (HLIM). METHODS Observational case report with clinical and ocular imaging features of a patient with HLIM. RESULTS A 31-year-old male patient presented with sudden diminution of vision in both eyes after accidental exposure to a handheld green laser. At presentation, best corrected visual acuity in both eyes was 20/100. Fundus examination showed vertical linear lesions radiating in dendritic patterns involving fovea in both eyes. Swept source OCT revealed hyper-reflectivity in outer nuclear and outer plexiform layers and disruption of the ellipsoid zone. OCT angiography at the level of choriocapillaris showed flow void areas suggesting choroidal ischaemia. CONCLUSION Handheld laser pointers can cause direct photothermal injury to retinal pigment epithelium and inner choroid. It is important to be aware of this clinical entity and its characteristic pattern of plaque like lesions at macula with linear radiating dendritic extensions.
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Affiliation(s)
- Raja Narayanan
- Smt Kanuri Santhamma Center for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Mudit Tyagi
- Smt Kanuri Santhamma Center for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India.,Uveitis and Ocular Immunology Services, L V Prasad Eye Institute, Hyderabad, India
| | - Niroj K Sahoo
- Smt Kanuri Santhamma Center for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Subhakar Reddy
- Smt Kanuri Santhamma Center for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Avinash Pathengay
- Retina and Uveitis Services, L V Prasad Eye Institute, Vishakapatnam, India
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Christodoulou E, Batsos G, Christou EE, Gorgoli K, Parikakis E, Karagiannis D, Kontomichos L, Stefaniotou M. Long-Term Outcomes following Intravitreal Ranibizumab for Choroidal Neovascularization Related to Nd:YAG Laser Macular Injury: A Case Report. Case Rep Ophthalmol 2023; 14:68-74. [PMID: 36820308 PMCID: PMC9938398 DOI: 10.1159/000529297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/15/2023] [Indexed: 02/24/2023] Open
Abstract
Choroidal neovascularization (CNV) secondary to Nd:YAG laser macular injury consists of a rare condition without standardized treatment. Herein, we present the long-term outcomes of a case with a spontaneous closure of a laser-associated macular hole that was followed by late-onset CNV and was successfully treated with intravitreal ranibizumab. A 32-year-old man suffered a macula injury in his right eye after accidental exposure to an 800-nm wave length Nd:YAG laser pulse. Ophthalmological examination demonstrated deterioration in visual acuity along with parafoveal and post-hyaloid hemorrhage. After 1 month, fundoscopy indicated the formation of a full-thickness macular hole. A close observation revealed spontaneous closure of the hole and visual improvement within the next month. One and a half year later, the patient presented with sudden visual distortion, while optical coherence tomography and fluorescein angiography disclosed the development of CNV. The patient was successfully treated with a single intravitreal injection of ranibizumab. The patient's condition has remained stable during an 8-year follow-up period. In conclusion, laser-induced macular injury consists of an increasingly remarkable condition that may have a profound impact on visual outcomes. Our case provides insight into the potential mechanisms of Nd:YAG laser injury and its complications, indicating that CNV may occur even in the long term, while anti-vascular endothelial growth factor may help maintain stable anatomic and functional outcomes.
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Affiliation(s)
- Eleni Christodoulou
- Department of Ophthalmology, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Georgios Batsos
- 2nd Ophthalmology Department, Ophthalmiatreio Eye Hospital of Athens, Athens, Greece
| | - Evita Evangelia Christou
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | | | - Efstratios Parikakis
- 2nd Ophthalmology Department, Ophthalmiatreio Eye Hospital of Athens, Athens, Greece
| | - Dimitrios Karagiannis
- 2nd Ophthalmology Department, Ophthalmiatreio Eye Hospital of Athens, Athens, Greece
| | - Loukas Kontomichos
- 2nd Ophthalmology Department, Ophthalmiatreio Eye Hospital of Athens, Athens, Greece
| | - Maria Stefaniotou
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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The OCT angular sign of Henle fiber layer (HFL) hyperreflectivity (ASHH) and the pathoanatomy of the HFL in macular disease. Prog Retin Eye Res 2022:101135. [DOI: 10.1016/j.preteyeres.2022.101135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
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Marinescu AI, Hall CM. Laser-Induced Maculopathy and Outcomes After Treatment With Corticosteroids and Lutein. Cureus 2021; 13:e18470. [PMID: 34692258 PMCID: PMC8526046 DOI: 10.7759/cureus.18470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 11/05/2022] Open
Abstract
This case report presents treatment outcomes for a patient with accidental laser-induced retinal injury. A 30-year-old man was evaluated for a sudden decrease of vision and metamorphopsia in his left eye after staring at a laser in a nightclub five days before presentation. Eye examination showed left visual acuity of 6/18-2 unaided, which improved to 6/12-2 on the pinhole test. Dilated fundoscopy showed a yellow-orange foveolar lesion in the left eye. Optic coherence tomography (OCT) showed an alteration of foveal anatomy predominantly involving the outer retinal layers, hyper-reflective vertical bands, and large cystoid change at the inner retina. Foveolar thickness was increased to 397 µ. Treatment was initiated with oral corticosteroids (prednisolone 0.5 mg/kg/day). At the one-week follow-up, left visual acuity improved to 6/12+2. Hardly any cystic changes were noted, with fewer hyper-reflective bands and less disruption at the outer layer. Treatment with prednisolone was continued and lutein capsules (20 mg/day) were added. At three weeks, the patient reported a return to normal vision, with left visual acuity of 6/6-2 unaided. On OCT, near-complete restoration of the macular structure was visualized. Although these results show positive clinical outcomes with combined oral corticosteroids and lutein over a short time for a typical case of laser-induced maculopathy, further review is recommended to determine the ideal treatment regimen.
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Li C, Li J, Chen X, Lu P. Laser-induced choroidal neovascularization: A case report and some reflection on animal models for age-related macular degeneration. Medicine (Baltimore) 2021; 100:e26239. [PMID: 34115011 PMCID: PMC8202587 DOI: 10.1097/md.0000000000026239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/19/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Laser induced maculopathy includes retinal photoreceptor disruption, macular hole, macular hemorrhage, and rarely choroidal neovascularization (CNV). Here we report a case of laser induced CNV that was treated by intravitreal anti-vascular endothelial growth factor (VEGF) injection and resulted in visual improvement and CNV resolution during 1-year follow up. In addition, the case of laser induced CNV treated with intravitreal anti-VEGF injections are reviewed for the first time in literature. PATIENT CONCERNS A 7-year-old boy presented to our department with blurred vision in his right eye for 2 months. The symptom immediately happened after the boy staring at the laser beam for a few seconds. Examination of ocular fundus with slit lamp showed yellowish lesion in macula in his right eye. DIAGNOSES CNV was confirmed by fundus examinations, including color fundus photograph, spectral domain optical coherence tomography, fluorescein angiography, and spectral domain optical coherence tomography angiography. INTERVENTIONS After the diagnosis of laser induced CNV, intravitreal ranibizumab (LUCENTIS, NOVARTIS) injection was performed. OUTCOMES After 1 injection of intravitreal ranibizumab, the best corrected visual acuity improved from 20/50 to 30/50 and CNV gradually regressed during 1-year follow up. LESSONS For young patients with laser induced CNV, intravitreal anti-VEGF injections may be helpful in visual improvement and CNV regression. Moreover, age seems to be a significant factor thus we propose that old animals may be more appropriate for laser induced CNV animal models of age-related macular degeneration.
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Affiliation(s)
- Caixin Li
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University
| | - Jianqing Li
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University
| | - Xinzhu Chen
- Department of Ophthalmology, Suzhou EENT Hospital, Suzhou, Jiangsu Province, China
| | - Peirong Lu
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University
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Wang X, Zhang T, Jiang R, Xu G. Vitrectomy for laser-induced full-thickness macular hole. BMC Ophthalmol 2021; 21:135. [PMID: 33714272 PMCID: PMC7956069 DOI: 10.1186/s12886-021-01893-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/01/2021] [Indexed: 12/28/2022] Open
Abstract
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.
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Affiliation(s)
- Xin Wang
- Eye Institute and Department of Ophthalmology Vision Sciences, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Ting Zhang
- Eye Institute and Department of Ophthalmology Vision Sciences, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Rui Jiang
- Eye Institute and Department of Ophthalmology Vision Sciences, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
| | - Gezhi Xu
- Eye Institute and Department of Ophthalmology Vision Sciences, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
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