Abstract
Purpose
To describe two cases of macular hemorrhage in young patients, both occurred after laser exposure and cannabinoid intake during a disco party.
Observations
Case 1: a 21-year-old man was evaluated at our Emergency Unit for sudden vision loss in the right eye (RE). Best-corrected visual acuity (BCVA) was count fingers in the RE and 20/20 in the left eye (LE). Fundus examination revealed a broad pre-retinal hemorrhage in macular region of RE, confirmed by optical coherence tomography. The patient reported vision loss, suddenly occurred after fixation of a laser source and cannabinoid intake during a disco party the night before. We administered a macular supplement and closely followed up the patient. After two months BCVA of the right eye was 20/20.
Case 2
The following day another 21-year-old man was referred to our Emergency Unit complaining of sudden vision loss in LE. As in Case 1, he reported to have fixed a laser beam as well as the consumption of cannabinoids at the same disco. BCVA was count fingers in the LE and 20/20 in the RE. Fundus examination showed a broad pre-retinal hemorrhage in macular region of LE. He had taken the macular supplement for two months and then the hemorrhage was reabsorbed.
Conclusion and importance
Laser exposure must be considered as a possible cause of macular hemorrhage. Furthermore, low cost of drugs and lack of formal control of laser sources may increase the emergence of new cases of retinal injuries especially among young people.
1
Introduction
Unilateral hemorrhage in the macular region of a young patient is a particularly rare condition that causes sudden vision loss. The two most frequent causes are previous trauma and Valsalva maneuver-induced retinopathy. Vascular alterations secondary to systemic diseases, such as diabetic retinopathy, hypertension, Terson’s syndrome, blood disorders and also ocular diseases may be potential causes that determine the development of macular hemorrhage. , Forms depending on external factors include those caused by laser beams.
We describe two cases of macular hemorrhage in two young patients, both of which occurred after exposure to laser sources and after the intake of cannabinoids at a disco party.
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Case 1
A 21-year-old man was referred to our Emergency Unit complaining of sudden vision loss in the right eye (RE). Medical history was otherwise unremarkable. Best-corrected visual acuity (BCVA) was count fingers in the RE and 20/20 in the left eye (LE). Slit-lamp examination of the anterior segment and intraocular pressure were unremarkable in both eyes. Dilated fundus examination of the RE showed a broad ovoid pre-retinal hemorrhage in the macular region. Optical coherence tomography (OCT) centered on the fovea showed an increase in central macular thickness due to a wide hyperreflective area located above the inner retina layers, under the inner limiting membrane (ILM) and shadowing the underlying retinal layers. Above the ILM there was a hyporeflective space under the hyaloid ( Fig. 1 – A, B). Fluorescein angiography (FA) of the RE showed macular hypofluorescence due to the blocking effect of the macular hemorrhage. Blood chemistry was normal. We questioned the patient about his recent medical history to seek a possible cause. He reported that vision loss had occurred suddenly after he had fixed a laser source during a disco party the night before. He mentioned he had taken synthetic cannabinoids that same evening. We therefore scheduled close follow-up: first at 5 days, then at 2 weeks, 1 month ( Fig. 1 – A1, B1), 45 days and 2 months. During this period the patient took no medication except a daily macular supplement containing lutein and turmeric.
At two months follow-up the wide ovoid pre-retinal hemorrhage in the macular region of the RE had almost disappeared and mild atrophic changes were detected in the foveal inner retina layers ( Fig. 1 – A2, B2). BCVA of the RE was 20/20.
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Case 2
The next day, another 21-year-old man was referred to our Emergency Unit complaining of sudden vision loss in his LE. Similarly to Case 1, he reported to have fixed a laser beam during the same disco party the night before. The patient admitted taking synthetic cannabinoids. He had no other medical history. BCVA was count fingers in the LE and 20/20 in the RE. Slit-lamp examination of the anterior segment and eye pressure were normal in both eyes. Dilated fundus examination showed a broad pre-retinal hemorrhage in the macular region of the LE, confirmed by FA. This excluded vascular damage or systemic pathologies, and there were no changes during the different stages of the examination. OCT showed an increase in the central macular thickness with a wide hyperreflective area located above the inner retina layers, under the ILM, corresponding to the hemorrhage with posterior shadowing ( Fig. 2 – A, B). Similarly to Case 1, we scheduled a strict follow-up discharging the patient with a macular supplement containing lutein and turmeric ( Fig. 2 – A1, B1).
