Retinopatía por puntero láser: presentación de dos casos / Handheld laser maculopathy: two case reports

El uso indebido de los punteros láser, especialmente el recreativo en los niños, puede causar lesiones retinianas que amenazan la visión. El daño retiniano que producen no está bien caracterizado, debido a que la mayoría de las publicaciones son casos aislados o series pequeñas. El tratamiento y el pronóstico visual es variable según la morfología del daño macular que presenten. En algunos casos, no existe tratamiento, y pueden evolucionar a la curación espontánea; sin embargo, otros precisan cirugía. En una serie de 13 casos, uno requirió cirugía, mientras que el resto necesitó solo observación. De estos 13 casos, 3 pacientes se curaron en forma espontánea, con agudeza visual de 10/10.Se describen dos pacientes de 16 y 12 años con disminución de agudeza visual tras el uso indebido de punteros láser. En el fondo de ojo, presentaron alteraciones maculares. La agudeza visual de ambos se recuperó completamente sin tratamiento.

The improper use of laser pointers, especially for recreational use in children, may cause sight-threatening retinal injuries. The retinal damage it is not well characterized because most publications are isolated cases or small series.The treatment and visual prognosis are variable according to the morphology of the macular damage. In some cases, there is no treatment, and spontaneous healing can be developed; however, others require surgery. In a series of 13 cases, 1 required surgery and the rest observation; 3 patients obtained a spontaneous healing with visual acuity of 10/10.We describe two patients aged 16 and 12 years with decreased visual acuity. Macular alterations appear in the fundus of the eye. The visual acuity of both recovered completely without treatment

Maculopathy from an accidental exposure to welding arc.

Welding light can cause photic retinal injury. We report binocular maculopathy induced by a brief exposure to electric arc welding light in a patient who could not equipped with protective device because of narrow space. A 47-year-old man performed electric arc welding for approximately 10-15 min without wearing protective device because of narrow space and subsequently experienced eye discomfort and decreased visual acuity. At the initial visit, his best corrected visual acuity was 0.5. Fundus examination, optical coherence tomography (OCT) and multifocal electroretinogram (mfERG) were performed. OCT showed disruption in the ellipsoid zone, and mfERG amplitudes in the central 10° were markedly reduced in both eyes. The decrease in visual acuity had been noted for at least 18 months. Using the proper protective device is essential in welding, despite short time periods of work. For patients with welding-induced photokeratitis, doctors should also consider the possibility of photic retinal injury.

Photic maculopathy: A review of the literature (ii). / Maculopatía fótica: revisión de la literatura (ii).

The human retina, as transducer of light energy, is especially exposed to light toxicity. Solar maculopathy has been the only form of photic maculopathy for millennia, often secondary to the observation of an eclipse. During the last century, technological advances have led to the appearance of new forms of photic maculopathy, related to the exposure to new forms of artificial light, such as welding devices and lasers. In recent years the general use of laser pointers has led to an upturn in interest in this pathology. The aim of this review is to offer an integrated view of the different types of photic maculopathy. Due to the extension of the topic, the review is presented divided into 2 parts. In this second part, atomic bomb maculopathy, laser maculopathy, iatrogenic forms of photic maculopathy, and foveomacular retinitis are presented.

Optical coherence tomography patterns and outcomes of contusion maculopathy caused by impact of sporting equipment.

BACKGROUND: To describe the patterns and outcomes of contusion maculopathy after ocular contusions resulting from accidental impact with sporting equipment. METHODS: We conducted a retrospective study of interventional case series. PATIENT POPULATION: Twenty-one eyes of 21 patients who sustained blunt ocular trauma while playing a sport. Intervention/Observation Procedure(s): Surgery or observation by optical coherence tomography (OCT). MAIN OUTCOME MEASURE(S): The morphologic changes within the macula in the early stages after injury and changes in visual function in the early and recovery stages after injury. RESULTS: In the early stage, OCT visualized four injury patterns: type Ι, commotio retinae (14.3%, 3 eyes) with increased reflectivity of the ellipsoid zone and retinal pigment epithelium; type II, incomplete macular hole(38.1%, 8 eyes) with three structural changes, i.e., a partial V-shaped macular hole, a jar-shaped macular hole with retinal tissue at the bottom, and a connective bridge attached to retinal tissues; type III, full-thickness macular hole (33.3%, 7 eyes); and type IV, foveal hemorrhage (14.3%, 3 eyes). During recovery, OCT images of types Ι and II showed almost normal macular morphology with better visual acuity (mean ± SD,0.02 ± 0.1 and 0.14 ± 0.21logMAR.). In types III and IV, the visual prognosis was poor (0.52 ± 0.34 and 0.22 ± 0.16), OCT images showed retinal atrophy at the fovea despite vitrectomy and sulfur hexafluoride (SF6) gas tamponade. CONCLUSION: Early OCT images identified four patterns of contusion maculopathy with different treatment outcomes. In types Ι and II, the visual function and retinal morphology remained intact. With types III and IV, respectively, the treatments of vitrectomy and SF6 gas tamponade for patients were effective.

Inadvertent self-induced macular laser injury in an 8-year-old girl.

An 8-year-old girl with a history of type 1 diabetes was referred for an evaluation of pigment changes in the right macula. Curvilinear hypopigmented streaks were noted in the fovea, with corresponding disruption of the photoreceptor layer on spectral domain optical coherence tomography. On further questioning, a history of laser pointer play 2 years prior was elicited, with acknowledgement of direct laser pointing in the child's eye. The family was advised to remove any commercial laser devices from the home, and observation of the pathology was recommended.

Bilateral maculopathy after exposure to a laser pointer: Optical coherence tomography angiography findings. / Maculopatía bilateral por exposición a puntero láser: hallazgos en la angiografía mediante tomografía de coherencia óptica.

CASE REPORT: A 36-year-old man went to the emergency department the day after exposure to a laser pointer. Funduscopy revealed dispersed macular pigment alterations, and optical coherence tomography showed a disruption of the retinal layers. The visual acuity was counting fingers in both eyes. Nine months later, optical coherence tomography angiography showed a rarefaction in the choriocapillaris vascular flow in the area of the laser injuries. DISCUSSION: The retinal layer mainly damaged by the laser injury was the retinal pigment epithelium. However, it is suggested that the laser injury could involve tissues beyond the retinal pigment epithelium, since a rarefaction of the choriocapillaris was found after exposure to the laser.

Damage to the macula associated with LED-derived blue laser exposure: A case report.

BACKGROUND: Light emitting diodes laser is emerging as an important source of light replacing conventional lights. It is widely used for illumination in the bar where young people love to go. But not everyone knows about the light damage to the eye especially to the macula. In this article, we report the case of a macular damage induced by LED-derived blue laser in a bar, studied with optical coherence tomography (OCT) to evaluate the retinal lesion and multifocal electroretinography (mfERG) to evaluate functional damage. CASE PRESENTATION: Four days after the photo injury to the right eye, the visual acuity was 0.5. Funduscopy revealed a round red lesion in the macula of the right eye. Fluorescein angiography (FA) revealed no leakage. OCT revealed a deficiency in the center of the fovea. MfERG revealed a reduction of the peak value in the right eye compared to the left eye. One month later, although the vision was 1.0 in the right eye, OCT revealed a hyporeflectivity of the ellipsoid zone. MfERG still showed a reduction of the peak value in the right eye compared to the left eye. CONCLUSION: We believe that general knowledge about laser injuries to the eye should be realized widely. We also think in cases of macular laser damage, the recovery of vision can not demonstrate the recovery of the function of photoreceptors.

Surgical treatment and optical coherence tomographic evaluation for accidental laser-induced full-thickness macular holes.

PurposeTo report OCT appearance and surgical outcomes of full-thickness macular holes (MHs) accidentally caused by laser devices.Patients and methodsThis retrospective case series included 11 eyes of 11 patients with laser-induced MHs treated by pars plana vitrectomy, internal limiting membrane (ILM) peeling, and gas or silicone oil tamponade. Evaluations included a full ophthalmic examination, macular spectral-domain optical coherence tomography (SD-OCT), and fundus photography. Main outcome measures is MH closure and final visual acuity; the secondary outcome was the changes of retinal pigment epithelium and photoreceptor layer evaluated by sequential post-operative SD-OCT images.ResultsFive patients were accidentally injured by a yttrium aluminum garnet (YAG) laser and six patients by handheld laser. MH diameters ranged from 272 to 815 µm (mean, 505.5±163.0 µm) preoperatively. Best-corrected visual acuity (BCVA) improved from a mean of 0.90 logMAR (range, counting finger-8/20) preoperatively to a mean of 0.34 logMAR (range, a counting finger-20/20) postoperatively (P=0.001, t=4.521). Seven of 11 patients (63.6%) achieved a BCVA better than 10/20. Ten patients had a subfoveal hyperreflectivity and four patients had a focal choroidal depression subfoveal preoperatively. At the last follow-up, all 11 eyes demonstrated the following: closure of the macular hole, variable degrees of disruption of external limiting membrane (ELM) and outer photoreceptor ellipsoid and interdigitation bands. In 10 eyes, the disruption was in the form of focal defects in the outer retina. After surgery, the subfoveal hyperreflectivity and focal choroidal depression remained.ConclusionAccidental laser-induced full-thickness macular holes can be successfully closed with surgery. Inadvertent retinal injury from laser devices, especially handheld laser injury has occurred with increasing frequency in recent years. However, there is a paucity of data regarding these types of injuries, mostly in the form of case reports. We hereby reported 11 eyes of 11 patients with laser-induced macular holes treated by vitrectomy. All the macular holes closed after surgery and the corresponding visual acuities significantly improved postoperatively.

Early changes in optic coherence tomography in a child with laser pointer maculopathy. / Cambios precoces en la tomografía de coherencia óptica en un niño con maculopatía inducida por puntero láser.

CASE REPORT: A 9-year-old boy referred due to visual loss in his right eye after playing with a laser pointer. In the first visit (12hours later) visual acuity (VA) was 0.15. A hypopigmented lesion was present in the fovea, and optic coherence tomography (OCT) showed vertical hyper-reflective bands. In the last visit (6 months later), VA had improved to 0.5, and OCT showed a well-defined area of outer retinal layer disruption. DISCUSSION: An inadequate use of laser pointers can induce severe and permanent visual loss.

Spontaneous closure of a blue laser induced full thickness macular hole. / Cierre espontáneo de un agujero macular de espesor completo secundario a exposición accidental a puntero láser azul.

CASE REPORT: A 14 year-old boy attended our clinic complaining of a scotoma after an accidental exposure to a 10W, 450nm laser beam from a blue-light handheld laser device. Optical coherence tomography confirmed a full thickness macular hole. As visual acuity (VA) remained 20/20 Snellen, observation was decided. Spontaneous closure was confirmed after one month. DISCUSSION: Reckless use of high-power handheld laser devices may induce severe retinal lesions, including full thickness macular holes. Observation is a sensible treatment option in this type of macular hole, especially when VA is preserved. The pathophysiology of these cases differs from senile full thickness macular holes.

Ultra-wide Field Imaging and Swept Source Optical Coherence Tomography of Ocular Electrical Injury in a Child.

History of trauma in children may be obscured and physicians often rely on signs for diagnosis. The authors discuss a case of electrical injury where ocular signs led to diagnosis of the cause of macular atrophy. A high index of suspicion must always be maintained in such atypical cases, and the setting of electrical injury to the body requires meticulous ocular examination. [J Pediatr Ophthalmol Strabismus. 2016;53:e69-e71.].

[Unilateral maculopathy in a young male patient: A photic laser injury]. / Une maculopathie unilatérale chez un patient jeune : un phototraumatisme induit par laser.

We report the case of a twenty-year-old man with a unilateral maculopathy responsible for an acute visual acuity loss and a sudden absolute central scotoma. His schizoid personality made the medical history fruitless. The patient's best corrected visual acuity was 20/60. Clinical examination revealed a strictly unilateral maculopathy with pigment remodeling and hyper-autofluorescent areas. Through this case report, we describe the characteristics of the lesion and the pathway to the diagnosis: a laser pointer-induced photic injury.

Intraoperative electrophysiological evaluations of macular function during peripheral scleral indentation.

Scleral indentation is widely used to examine the peripheral fundus, however it can increase the intraocular pressure (IOP) to high levels which can then affect retinal function. We evaluated the effects of scleral indentation on the macular function electrophysiologically. Intraoperative focal macular electroretinograms (iFMERGs) were recorded with and without controlling the IOP in 7 eyes. Without IOP control, the IOP increased from 21.7 ± 4.9 to 92.7 ± 20.2 mmHg significantly (P = 0.020) and the amplitudes of the b-wave (from 6.29 ± 1.160 to 3.71 ± 1.98 uV, P = 0.007), on-photopic negative response (from 2.29 ± 0.99 to 0.72 ± 0.47 uV, on-PhNR, P = 0.005), and d-wave (from 2.57 ± 0.41 to 1.64 ± 0.69 uV, P = 0.007) decreased significantly soon after beginning the indentation. All values returned to the baseline levels after releasing the indentation. In the eyes with IOP controlled, the IOP and the amplitude of all components did not change significantly during and after the indentation except the on-PhNR amplitude which was significantly reduced during the indentation. The changes in the iFMERGs and macular function caused by scleral indentation were transient and reversible. The changes can be minimized by controlling the IOP.

[Comparative analysis of the characteristics of bilateral rhegmatogenous retinal detachment].

OBJECTIVE: To investigate the characteristics of bilateral rhegmatogenous retinal detachment (RRD) in a hospital-based population. METHODS: Six hundred and three patients diagnosed with bilateral RRD in the Beijing Tongren Hospital between January 2000 and January 2014 were identified and included into the study. The clinical features including the age when retinal detachment occurrence, time interval between the occurrence of the bilateral RRDs, predisposing characteristics such as myopia, trauma, et al. were recorded by a chart review. RESULTS: Out of 8 283 patients treated for primary RRD in the study period, (7.30±2.45)%(603 patients) developed a RRD in the contralateral eye, with a mean age of (30.76 ± 15.31)years (range: 2-68) when the first RRD occurred. 4.8% of the patients primarily presented with a simultaneous bilateral RRD. Most RRD occurred firstly in the left eye (52.90%). Compared with the follow eye, the first RRD occurred with more macula detachment (P=0.03, OR: 1.59, 95%CI: 1.04-2.45) and retinal proliferation (P=0.04, OR: 1.57, 95% CI: 1.02-2.42), the visual outcome was more worse. Mean interval between the bilateral RRDs was (3.73±7.05) years (mean±standard deviation, range: 0-56 years) The younger, more severe symptoms of the firstly occurred RRD, the shorter interval between the bilateral RRD. Time interval between the bilateral RRD was shorter in those RRD firstly occurred with macula detachment, giant tears, horse-shoe tear, located in the temporal superior region, or with retinal degeneration. Compared with highly myopic eyes, the interval between the bilateral RRD were shorter in moderately myopic eyes. CONCLUSIONS: For patients newly diagnosed with RRD, regardless of age, are required to a lifelong follow-up for the contralateral eye, especially within one year. Patients who were young, with heavier symptoms, low to moderate myopia or present with retinal degeneration, should be closely followed up in a short time after the first RRD occurred.