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High-Power Handheld Blue Laser-Induced Maculopathy

The Results of the King Khaled Eye Specialist Hospital Collaborative Retina Study Group
Published:November 04, 2013DOI:https://doi.org/10.1016/j.ophtha.2013.09.006

      Purpose

      To report various types of maculopathy caused by momentary exposure to a high-power handheld blue laser.

      Design

      Consecutive case series.

      Participants

      Fourteen eyes of 14 patients.

      Methods

      Patients with a history of eye exposure to a blue laser device (450 nm and a power range of 150–1200 mW) to a single institution were included. Evaluation included a full ophthalmic examination, fundus photography, macular spectral-domain optical coherence tomography, and fundus fluorescein angiography.

      Main Outcome Measures

      Analysis of the types of maculopathy and vitreoretinal pathologic features.

      Results

      All patients were young males. The most common setting for injury was accidental at play. The types of maculopathies encountered were: a full-thickness macular hole (FTMH) in 4 eyes, a premacular subhyaloid hemorrhage in 5 eyes, premacular sub–internal limiting membrane hemorrhage in 2 eyes, an outer retinal disruption at the fovea in 1 eye, an epimacular membrane in 1 eye, and a schisis-like cavity in 1 eye. Best-corrected Snellen visual acuity at presentation ranged from 20/40 to 4/200 (mean, 20/290). Only 4 eyes (29%) improved spontaneously with increase in vision, whereas 10 eyes (71%) required intervention. The latter consisted of neodymium:yttrium–aluminum–garnet hyaloidotomy in the 5 eyes with subhyaloid hemorrhage and pars plana vitrectomy (PPV) for the eyes with FTMH and epimacular membrane. All 4 FTMH were closed successfully after PPV. Final mean best-corrected visual acuity in all cases was 20/35 (range, 20/15–20/300).

      Conclusions

      Exposure to high-power handheld laser devices can cause a variety of maculopathies that can reduce central vision permanently. Although vision may improve spontaneously, most cases require intervention. Unrestricted access to commercially available high-power handheld laser devices is dangerous and public awareness should be encouraged.
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