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

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.

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.

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.

PERFLUOROCARBON LIQUIDS' ABILITY TO PROTECT THE MACULA FROM INTRAOCULAR DROPPING OF METALLIC FOREIGN BODIES: A Model Eye Study.

PURPOSE: To examine the utility of perfluoro-n-octane (PFO) in balanced salt solution (BSS) to shield the macula from the impact of dropped metallic intraocular foreign bodies (IOFBs) by modeling scenarios in which they may fall during surgical removal. METHODS: Model eyes were filled with various fluid mixtures (Group 1: 10% PFO/90% BSS; Group 2: 100% BSS; Group 3: 100% PFO; Group 4: 10% PFO/90% air; Group 5: 10% BSS/90% air). In Groups 1, 4, and 5, the 10% fluid volume covered the theoretical macula. For each fluid mixture, up to 30 IOFB drop scenarios were performed for each of the 5 sample IOFBs from 3 locations. Trajectories were recorded using a camera attached to a Zeiss operating microscope (Carl Zeiss, Jena, Germany). The percentages of IOFBs impacting the macula were calculated and Fisher exact test was used to assess differences. RESULTS: In Group 1, 93% (417/450) of the dropped IOFBs were deflected by the PFO-BSS interface compared with 0% (0/500) in Groups 2, 3, 4, and 5 (P < 0.01). With the exception of the heaviest IOFB (24.4 mg), which impacted the macula in 30% of tests when dropped from the superior posterior segment (P < 0.01), all other IOFBs (2.8-13.4 mg) were deflected by the PFO-BSS interface in 100% of Group 1 drops (P < 0.01). CONCLUSION: As demonstrated by these simulations, the PFO-BSS interface can deflect IOFBs dropped during surgery in a wide range of scenarios, especially when the IOFB is of lower mass.

Macular hole after intravitreal bevacizumab injection for choroidal neovascularisation.

PURPOSE: The aim of this study was to report a patient who developed a full-thickness macular hole following intravitreal bevacizumab injection. METHODS: A 78-year-old patient diagnosed with choroidal neovascularisation (CNV) was treated with intravitreal bevacizumab injection. RESULTS: On the first follow-up visit, a decrease in visual acuity was seen and a small full-thickness macular hole with complete resolution of subretinal fluid was observed in optical coherence tomography (OCT). A second intravitreal injection of bevacizumab was performed. At the subsequent visit, a serious loss of visual acuity and limited regression in choroidal neovascularisation was seen. The OCT showed a larger full-thickness macular hole. CONCLUSIONS: This case demonstrates that intravitreal bevacizumab injection might be responsible for the development of a macular hole. Clinicians should be cautious that a macular hole may be a complication of intravitreal bevacizumab injection.

Macular displacement following rhegmatogenous retinal detachment repair.

AIMS: To investigate the incidence of macula displacement and symptoms of distortion following rhegmatogenous retinal detachment (RRD) repair, quantify the displacement where seen and further characterise the nature of the displacement. METHODS: Consecutive patients undergoing primary RRD repair were assessed postoperatively with fundus autofluorescence and optical coherence tomography imaging, and the extent of macula displacement quantified using a novel means. Findings were examined for correlations with symptoms and pre-operative features. RESULTS: Macula displacement was evident postoperatively in 72% of 32 consecutive fovea-involving detachments treated with vitrectomy and gas. It was also evident in 5/17 foveal-sparing cases treated with vitrectomy and gas and in two of two patients with fovea-involving detachments treated with vitrectomy and oil. There was a significant correlation between the presence of macula displacement and symptoms of distortion in the early postoperative period (p=0.013). Symptomatic patients described bending of lines with or without objects appearing smaller or narrower in the operated eye. Quantifying the displacement demonstrated that the extent of displacement was associated with distance from the optic disc (p=0.005) and the extent of retinal detachment. CONCLUSIONS: Displacement of the macula is common following RRD repair and heterogeneous in nature. Most affected patients are symptomatic in the early postoperative period.

Persistent submacular fluid diagnosed with optical coherence tomography after successful scleral buckle surgery for macula-off retinal detachment.

Crataegus species have been widely used in herbal medicine, especially for the hearth diseases. In the present study, the effect of Crataegus aronia var. dentata Browicz extract on partially hepatectomized rats was investigated with biochemical and TUNEL apoptosis assays. The extracts of the plant at the concentrations of 0.5 and 1 ml/100 g body weight/day were administered orally to the two experimental groups including partially hepatectomized rats for 42 days. At the end of the experimental period, animals were sacrificed, blood was collected for the assessment of serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT), and the liver tissue was used for TUNEL assay. In biochemical assay, it was found a significant decrease in the levels of serum ALT and AST in the experimental groups. On the other hand, the plant extract did not cause any significant changes in the level of GGT in these groups. In apoptosis assay, TUNEL positive hepatocytes could not be detected in both experimental groups. The present findings can suggest that Crataegus aronia var. dentata Browicz extract can decrease the levels of serum ALT and AST and play a role in apoptosis of hepatocytes in the liver of partially hepatectomized rats. However, further studies are required to confirm the effects of the plant extract on hepatoprotection and apoptosis in the regenerating liver after partial hepatectomy in animal models.

Spectral-domain optical coherence tomography in lightning-induced maculopathy.

The authors report a case of lightning-induced chorioretinal burn accompanied by mild anterior segment injuries. Spectral-domain optical coherence tomography images were used to document the progressive retinal and choroidal changes. As evidenced by this report, despite being sight-threatening, such injuries may allow for a significant functional recovery.

Evolution of severe lightning maculopathy visualized with spectral domain optical coherence tomography.

The authors report a case of lightning maculopathy with serial spectral domain optical coherence tomographs that, for the first time, elegantly illustrate the natural history of this uncommon, ominous condition.

A case of accidental macular injury by Nd: YAG laser and subsequent 6 year follow-up.

Here, we report the case of a patient who sustained Nd: YAG laser macular injury with subsequent 6 year follow-up evaluation. A 23-year-old female was accidentally exposed to a Q-switched Nd: YAG laser without protective goggles. Upon initial evaluation, the best-corrected visual acuity of her affected eye was 20/100 OD. Fundoscopic examination revealed a macular laser burn and vitreous hemorrhage. Corticosteroids, in the form of 60 mg prednisolone, were administered orally with a 10 mg per week taper. Nineteen days following exposure, fundoscopic examination revealed a distinct epiretinal membrane which resolved within six months. The best-corrected visual acuity of the affected eye remained 20/100 OD. This clinical course is similar to those of previously reported cases including vitreous hemorrhage and subsequent epiretinal membrane formation. However, visual acuity did not recover despite spontaneous regression of the epiretinal membrane and at 6 year follow-up, there was neither choroidal neovascularization nor macular hole formation.

Surgical repair of iatrogenic macular hole secondary to vitrectomy for long-standing traumatic retinal detachment.

The authors describe the successful surgical repair of an iatrogenic macular hole. A 38-year-old woman underwent pars plana vitrectomy with a belt buckle and membrane peeling for long-standing total traumatic retinal detachment. Although retinal reattachment was achieved, a macular hole was detected postoperatively. The hole was initially monitored for 2 months to allow for spontaneous closure; however, it enlarged from 440 to 710 microm. Best-corrected visual acuity was 20/400. Silicone-oil removal was performed along with dye-assisted internal limiting membrane peeling and gas tamponade. Closure of the macular hole was observed 1 month after treatment. Visual acuity improved to 20/120 by the last follow-up examination 1 year after treatment.

Optical coherence tomography of traumatic maculopathy following blunt trauma with sugarcane.

An unusual case of traumatic maculopathy following blunt trauma with a sugarcane stick is reported in a 12-year-old boy. An area of parafoveal exudates associated with decrease in visual acuity was observed in the affected eye of the patient. Baseline parameters related to the best-corrected visual acuity, visual fields, fundus photographs, fluorescein angiography, and macular optical coherence tomography were performed and the patient was observed for 6 months with conservative management. There was complete resolution of the exudates with commensurate increase in the best-corrected visual acuity over this period. This unusual presentation of traumatic maculopathy is discussed along with the role of optical coherence tomography in such cases.

Management of traumatic macular holes: case report / Tratamento do buraco macular traumático: relato de caso

Traumatic macular hole is a disease whose pathogenesis is not fully understood and the best treatment guideline is controversial. We report 2 cases of traumatic macular hole with different treatment approaches. In the first case, a 9-year-old boy presented with a traumatic macular hole secondary to blunt ocular trauma with a stone, and initial vision of 20/300. He underwent surgical repair and his final vision was 20/70 with hole closure after a 1 year follow-up. In the second case, a 20-year-old woman suffered a penetrating bullet wound on the left side of her forehead. The injury caused optic nerve head avulsion in the left eye with loss of light perception. The right eye had a traumatic macular hole and signs suggestive of sclopetaria chorioretinitis, with 20/60 vision. This case was initially observed and vision improved to 20/30 with reduction of the hole diameter. Vision and hole diameter remained stable after 8 months.

O buraco macular traumático é doença cuja patogênese não é totalmente esclarecida e a melhor conduta terapêutica ainda é controversa. Relatamos 2 casos de buraco macular traumático para os quais adotamos condutas diferentes. No primeiro caso, um menino de 9 anos apresentou buraco macular traumático secundário a trauma ocular contuso com uma pedra, com visão inicial de 20/300. Foi submetido a tratamento cirúrgico e obteve visão final igual a 20/70 com buraco fechado após 1 ano de seguimento. No segundo caso, mulher de 20 anos sofreu traumatismo penetrante por projétil de arma de fogo na fronte, do lado esquerdo. O trauma causou avulsão do nervo óptico no olho esquerdo com perda de percepção luminososa neste olho. No olho direito apresentou buraco macular traumático e sinais sugestivos de coriorretinite esclopetária, com acuidade visual igual a 20/60. O caso foi inicialmente observado e a visão melhorou para 20/30 com diminuição do diâmetro do buraco. A visão e o diâmetro do buraco mantiveram-se estáveis por 8 meses.

Accidental Nd:YAG laser-induced choroidal neovascularization.

BACKGROUND: There are few reports in the literature to describe the natural history of an occupational Nd:YAG laser-induced retinal injury. METHODS: The chronological response to a Nd:YAG laser-induced injury was studied in a 48-year-old male using the techniques of color fundus photography, fluorescein angiography and optical coherence tomography. When he developed choroidal neovascularization his response to photodynamic therapy with verteporfin was recorded. RESULTS: The patient initially developed a macular hole, which spontaneously closed. Three months after the injury a choroidal neovascular membrane developed. This stabilized after the use of photodynamic therapy. CONCLUSIONS: Surgical closure of Nd:YAG induced macular holes should be delayed to allow spontaneous closure. Photodynamic therapy was successful in treating choroidal neovascularization in this case.

[Macular hole associated with paintball ocular trauma]. / Paintball jako przyczyna otworu w plamce--opis przypadku.

PURPOSE: A presentation of two patients with macular hole after ocular trauma due to paintball. MATERIAL AND METHODS: HRT, OCT, SOCT and visual field examinations were performed preoperatively and on 3 postoperative visits. Patients underwent pars plana vitrectomy with trypan blue staining. RESULTS: Final visual acuity 0.6 was achieved in the first patient 6 months after surgery. Best corrected visual acuity 0.2 was achieved in the second patient 3 months after surgery. Macular hole closure was observed on OCT, SOCT, HRT and indirect ophthalmoscopy examination. CONCLUSIONS: Pars plana vitrectomy with trypan blue staining and fluid-air exchange is a safe procedure in posttraumatic macular holes. HRT, Oct and SOCT are valuable tools for diagnosis of macular holes and for control after surgical intervention.

Bilateral macular cyst after lightning visualized with optical coherence tomography.

The authors report a 14-year-old girl who was struck by lightning with bilateral macular cyst that was diagnosed with optical coherence tomography (OCT). Her fundus examination revealed bilateral macular lesions that simulated macular holes. The Watzke-Allen sign was negative in the right eye and positive in the left eye. Fluorescein angiography showed a foveal window defect in both eyes. OCT demonstrated a small foveal cyst evident as a hyporeflective lucency, visible just anterior to the retinal pigment epithelium/choriocapillaris complex in both eyes. OCT seems to be useful in the evaluation of lighting maculopathy to rule-out full-thickness macular hole in these cases, and avoid unnecessary surgery.

[Bilateral macular cysts secondary to electric current strike. A case report]. / Quistes maculares bilaterales inducidos por descarga eléctrica. Presentación de un caso.

OBJECTIVE: To report the clinical and tomographic findings in a case of maculopathy secondary to high-tension electric current strike. CASE REPORT: A 27-year-old male refers a reduction in his visual acuity after electric strike. Visual acuity was 0.05 in both eyes. Circular reddish macular lesions measuring 400 micro m in RE and 200 micro m in LE were evident. Optical coherence tomography (OCT) showed intraretinal foveal cysts. At the third month follow-up visit, visual acuity had improved to 0.4 in RE and 0.5 in LE. Clinical and tomographic evaluation showed a reduction of the foveal cysts. DISCUSSION: Electricity affects retinal pigment epithelium and retina by thermal denaturation. OCT provides a conclusive diagnosis.