20.1

Laser Injury (Photothermal and Photomechanical)

Introduction:

Accidental laser injuries to the retina are uncommon, but can occur with photothermal injury (typically high-powered handheld laser pointers) and/or photomechanical injury (typically research and military devices).

Clinical Features:

The affected region of the retina is typically the central macula. In the acute setting, laser injuries produce a yellow subretinal lesion that can be of varied appearance (Fig. 20.1.1). Within a short time, the affected area becomes pigmented and over time this appearance can resolve leaving more subtle retinal pigment epithelium disturbances.

Figure 20.1.1 Color photograph shows yellow subretinal deposits in a splotchy pattern within the central macula. This patient was exposed to a high-powered handheld class 3B laser pointer.

OCT Features:

A significant photothermal laser injury causes retinal trauma identical to photocoagulation. On OCT, this is seen as localized outer retinal, IS–OS/ellipsoid zone, and RPE disruption in the acute setting (Figs 20.1.2 and 20.1.3). The inner retina may also be affected (Fig. 20.1.4

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1. Central Serous Chorioretinopathy
2. Central Retinal Artery Occlusion
3. Metastatic Choroidal Tumor
4. Choroidal Rupture and Subretinal Hemorrhage

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