First Author: L.Juaristi Eizmendi SPAIN
Co Author(s): A. Chamoun Olea L. Ansa Echegaray C. Irigoyen
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To describe the characteristics of a laser induced macular hole by Diode laser with spectral domain optical coherence tomography (SD-OCT) of a 41-years-old man and to make a review of all laser induced macular damages reported in the literature.
Ophthalmology department of Donostia University Hospital, San Sebastián, Spain. Observational case report and review of the literature of a macular hole induced by a 38J diode laser in a 41-year-old man while he was repairing a hair removal laser machine.
We report the clinical course of a patient after a 38J diode laser impact in his left eye causing a macular injury and we report the SD-OCT changes during the follow up at one week, one month and three months after the episode. In each visit a complete ophthalmological examination was done, with biomicroscopy, fundus examination, macular SD-OCT and visual acuity. A review of the literature was done, searching for all macular injuries produced by different types of laser. We reviewed the treatment, the spontaneous macular hole closing rate and the OCT changes described. We analysed the visual outcomes both in the group with the patients with observational treatment and the patients that underwent surgery.
Visual acuity of the left eye at the time of presentation was 1.3 LogMAR. Anterior segment slit-lamp biomicroscopy examination showed no abnormalities. Retinal slit-lamp biomicroscopy examination revealed a yellowish raised foveal injury. Macular SD-OCT showed at ten hours after the accident a “bullet” shape hyperreflective lesion in the outer retina. One week after, the SD-OCT revealed a macular hole and hyperreflective excrescences in the RPE. In the 4 week visit the SD-OCT showed enlargement of the macular hole (700µm), reabsorption of the foveal deposits and intraretinal cysts with raised edges. At the last follow up the size of the macular hole did not change and the visual acuity did not improve. We recommended surgery to the patient, but he refused to have surgery.
All types of laser can induce macular damage depending on the colour (wavelength), power, time of exposure and distance. There is no evidence about which treatment to follow. At the time of the accident most authors recommend oral corticosteroids. Recent reports suggest early surgery because the rate of spontaneous closure is low, except macular holes of less than 200µm, that can be observed. The patients that underwent surgery had a better visual recovery with a 78.6% closure rate. For the handheld lasers, the blue lasers are the ones that have more risk to develop macular hole. The SD-OCT changes found in our patient are “bullet” shape hyperreflective excrescences in the RPE in the first week, enlargement of the macular hole in the first month with intraretinal cysts and raised edges.