Patients and Methods

The case series presented herein is part of a larger comprehensive study of laser-induced ocular injuries that aims to highlight the emerging dangers of high-powered lasers. It was approved by the Internal Review Board/Ethical Committee at King Khaled Eye Specialist Hospital (KKESH), Riyadh, Saudi Arabia. An informed consent to render treatment was obtained from every patient (or legal guardian, if minor) prior to surgery. From January 2012 to May 2014, 17 patients presented to King Khaled Eye Specialist Hospital and King Abdulaziz University Hospital, Riyadh, Saudi Arabia with full-thickness MH following monocular exposure to a handheld blue laser device. The clinical features of 4 of the 17 patients were previously published. All patients recognized the laser device when they were shown a sample on presentation. Based on the label, this laser device has a wavelength of 450 nm and a power of up to 2000 mW.

Initial and follow-up evaluation included Snellen best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, color fundus photography, and macular spectral-domain optical coherence tomography (SD OCT) scanning (Spectralis HRA; Heidelberg Engineering, Heidelberg, Germany, or Cirrus; Carl Zeiss Meditec, Inc, Dublin, California, USA). The macular hole minimum diameter and base diameter (at the level of retinal pigment epithelium) of the macular hole were measured using the caliper of the software at the horizontal line scan crossing the macular hole center.

The surgeries were performed by multiple surgeons and general anesthesia was used because of the young age of the patients. The surgical technique in all patients consisted of 23 gauge pars plana vitrectomy, posterior hyaloid peeling, brilliant blue–assisted internal limiting membrane peeling, and fluid-air exchange, followed by gas (sulfur hexafluoride or perfluoropropane) or 5000 centistokes silicone oil tamponade. The choice of tamponade was according to the surgeon’s preference. All patients were instructed to assume strict face-down positioning for at least 5 days postoperatively. Snellen BCVA was converted to logarithm of the minimal angle of resolution (logMAR) for statistical analysis.

Results

There were 17 eyes of 17 patients with full-thickness MH ( Table ). All patients were young and male with a mean age of 18 (±4.3) years (range, 11–30 years). All injuries were inflicted by others during play, except for 1 patient in whom the injury was self-inflicted. Based on patients’ description, the duration of exposure was estimated to be less than a second in all cases. The approximate distance from the device to the victim’s eye was 0.5–2 meters (mean: 0.95 meters). The interval from the time of injury to presentation to the hospital ranged from 2 days to 16 months. BCVA at presentation ranged from 20/30 to 2/200 (mean: 1.02 logMAR; Snellen equivalent 20/210). Clinically, a round or oval-shaped full-thickness MH was detected in all eyes. In addition, faint whitening was observed at the base of the MH in all eyes. Also, tiny yellowish dots were seen in the bed as well as under the margins of the MH in 6 eyes. These findings were present in both acute and chronic cases ( Figure 1 , Top left and Top right). On SD OCT the presence of a full-thickness MH was confirmed in all eyes. Cystic changes at the margin were seen in 16 out of 17 eyes. The yellowish dots seen on fundus examination appeared as excrescences at level of the apical surface of the retinal pigment epithelium (RPE) on SD OCT (RPE) ( Figure 1 , Bottom). The MH size was variable. The mean macular hole minimum diameter at presentation was 351 μm (ranging from 168 to 620 μm; SD ± 151.7 μm) and the mean macular hole base diameter was 733 μm (ranging from 184 to 1150 μm; SD ± 331 μm).

Clinical and optical coherence tomography findings in high-power handheld blue laser–induced macular hole. (Top left) Fundus photograph of the right eye of Patient 17 showing a round full-thickness MH with faint whitening at the level of the retinal pigment epithelium (RPE) in the base of the hole (arrow). Multiple deep yellowish dots are shown around the MH (arrowhead). (Top right) Fundus photograph of the left eye of Patient 12 showing a semi-triangular-shaped full-thickness MH with a whitish streak at the level of the RPE in the base of the hole. Yellowish dots are seen at the margins (arrow). (Bottom) Macular spectral-domain optical coherence tomography of the same patient shown at Top left, showing a full-thickness MH and excrescences at the level of RPE (arrows) corresponding to the yellowish dots seen clinically.

Eight patients were observed for a period ranging from 3 to 9 months, of which 7 elected to be observed for longer than 3 months owing to their reluctance to proceed with surgery. These were reassessed according to physician best judgment at an interval of 2–3 months with examination and SD OCT. In all observed patients, the mean macular hole minimum diameter at presentation was 276 μm (ranging from 168 to 561 μm; SD ± 139.9 μm) while the mean macular hole base diameter was 503.7 μm (ranging from 184 to 958 μm; SD ± 313.7 μm). After observation, the mean macular hole minimum diameter was 312 μm (ranging from 0 to 800 μm; SD ± 237.9 μm) while the mean macular hole base diameter was 641.5 μm (ranging from 0 to 1242 μm; SD ± 437 μm). In 6 of these patients (6 eyes), the MH enlarged in size ( Figure 2 ). In 1 patient the MH size remained stable and in only 1 patient, whose eye had the smallest MH (minimum diameter 168 μm and base diameter 184 μm) in this series, did the MH close spontaneously ( Figure 3 ). The faint whitening that was seen in all cases did not change in appearance with observation.

Persistent full-thickness macular hole induced by high-power handheld blue laser despite 5 months of observation: Patient 8. (Left) Spectral-domain optical coherence tomography of the left macula depicting a full-thickness macular hole (MH) with elevated margins and cystic changes within them. The minimum diameter and base diameter of the macular hole measured 183 μm and 327 μm, respectively. (Right) Spectral-domain optical coherence tomography obtained after 5 months of observation showing an open MH with increased cystic changes. The minimum diameter and base diameter of the macular hole measured 225 μm and 378 μm, respectively.

Spontaneous closure of full-thickness macular hole caused by high-power handheld blue laser: Patient 9. (Left) Spectral-domain optical coherence tomography scan of the left macula showing a slit-like full-thickness macular hole. The minimum diameter and base diameter of the macular hole measured 168 μm and 184 μm, respectively. (Right) Spectral-domain optical coherence tomography scan obtained 9 months after injury showing a closed macular hole with an abnormal foveal contour and a persistent small defect of the ellipsoid zone.

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

1. The Importance of A Priori Statistical Planning in Controlled Clinical Trials
2. Frequency Doubling Technology Perimetry and Changes in Quality of Life of Glaucoma Patients: A Longitudinal Study
3. Corneal Cross-linking as an Adjuvant Therapy in the Management of Recalcitrant Deep Stromal Fungal Keratitis: A Randomized Trial
4. Short-Term Changes in Choroidal Thickness After Aflibercept Therapy for Neovascular Age-Related Macular Degeneration

Stay updated, free articles. Join our Telegram channel

Join