Non-Therapeutic Laser Retinal Injury

Bilateral Foveal Damage Induced by Indirect Picosecond Nd:YAG Laser Exposure: A Case Report

Introduction: Accidental retinal injuries caused by lasers without appropriate eye protection are not rare; most cases are unilateral. We report the case of a medical nurse who sustained bilateral foveal damage through indirect exposure to a picosecond dermal laser. Case Presentation: A 23-year-old nurse working in a cosmetic surgery clinic was using a picosecond KTP/Nd:YAG laser for tattoo removal. Because the procedure was complicated, she neglected the use of protective eyewear and experienced dazzle. Thirty minutes after starting the procedure, she developed central scotomas in both eyes. We examined her eyes the next day. Ophthalmologic examination revealed best-corrected decimal visual acuity (BCVA) of 0.6 in the right eye and 0.3 in the left eye. Spectral domain-optical coherence tomography showed a hyperreflective inner retinal layer with a lamellar defect and focal outer retinal detachment in the right eye; the left eye exhibited intra- and subretinal foveal hemorrhages. Injections of sub-Tenon's triamcinolone acetonide (12 mg/0.3 mL) in the right eye and intravitreal tissue plasminogen activator (30 μg/0.05 mL) in the left eye were administered on the same day. Two weeks later, a full-thickness macular hole (FTMH) was identified in the right eye; pars plana vitrectomy was required 6 weeks after initial presentation. Because the FTMH failed to close, a second procedure was performed 2 months later. One year after initial presentation, BCVA in the right eye had improved to 0.4. Although the FTMH remained closed, an outer retinal layer defect persisted. In the left eye, foveal hemorrhage resolved within 1 month of initial presentation. At the 1-year follow-up, BCVA in the left eye was 0.4; outer retinal layer disruption was evident at the central fovea. Conclusions: Continuous Nd:YAG laser exposure during cosmetic procedures likely caused the bilateral foveal damage observed in this case. All individuals using lasers must be aware of the importance of protective goggles.

Co-grafts of Human Embryonic Stem Cell Derived Retina Organoids and Retinal Pigment Epithelium for Retinal Reconstruction in Immunodeficient Retinal Degenerate Royal College of Surgeons Rats

End-stage age-related macular degeneration (AMD) and retinitis pigmentosa (RP) are two major retinal degenerative (RD) conditions that result in irreversible vision loss. Permanent eye damage can also occur in battlefields or due to accidents. This suggests there is an unmet need for developing effective strategies for treating permanent retinal damages. In previous studies, co-grafted sheets of fetal retina with its retinal pigment epithelium (RPE) have demonstrated vision improvement in rat retinal disease models and in patients, but this has not yet been attempted with stem-cell derived tissue. Here we demonstrate a cellular therapy for irreversible retinal eye injuries using a "total retina patch" consisting of retinal photoreceptor progenitor sheets and healthy RPE cells on an artificial Bruch's membrane (BM). For this, retina organoids (ROs) (cultured in suspension) and polarized RPE sheets (cultured on an ultrathin parylene substrate) were made into a co-graft using bio-adhesives [gelatin, growth factor-reduced matrigel, and medium viscosity (MVG) alginate]. In vivo transplantation experiments were conducted in immunodeficient Royal College of Surgeons (RCS) rats at advanced stages of retinal degeneration. Structural reconstruction of the severely damaged retina was observed based on histological assessments and optical coherence tomography (OCT) imaging. Visual functional assessments were conducted by optokinetic behavioral testing and superior colliculus electrophysiology. Long-term survival of the co-graft in the rat subretinal space and improvement in visual function were observed. Immunohistochemistry showed that co-grafts grew, generated new photoreceptors and developed neuronal processes that were integrated into the host retina. This novel approach can be considered as a new therapy for complete replacement of a degenerated retina.

Laser-Induced Maculopathy and Outcomes After Treatment With Corticosteroids and Lutein

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.