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Nicola G Ghazi, Sulaiman Alsulaiman, ; Full Thickness Macular Hole secondary to High Power, Handheld, Blue Laser: Natural History and Management Outcomes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):292.
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To report the natural history and management outcomes of macular hole caused by momentary exposure to a high-power, handheld, blue laser devise
This is a consecutive case series of 15 eyes of 15 patients who presented with macular hole caused by exposure to a blue laser device (450 nm and a power range from 150 mW to 1200 mW) to a single institution. Evaluation included a full ophthalmic examination, fundus photography, macular spectral-domain optical coherence tomography and fundus fluorescein angiography. The main outcome measures included the visual and anatomical outcomes
All patients were young males. There were 11 eyes with full-thickness macular hole (FTMH) and 4 eyes with stage 1 holes compromising 2 with outer retinal disruption in the fovea and 2 with foveal schisis-like cavity. Best corrected Snellen visual acuity at presentation ranged from 20/30 to 20/400 (mean 20/165). All eyes were observed for at least 3 months prior to any intervention. Six eyes with FTMH underwent pars plana vitrectomy, internal limiting membrane peeling along with gas or silicone oil tamponade. Five of the six operated eyes had complete closure of the macular hole with marked visual recovery. One eye had a persistently open hole following surgery attributed to lack of positioning. The remaining five eyes with FTMH did not undergo surgery for various reasons and none of them closed spontaneously. The 4 eyes with outer retinal disruption and foveal schisis-like changes healed spontaneously with complete visual and anatomical recovery. The final mean BCVA for all eyes was 20/53 (range: 20/30 to 20/125).
FTMH can result from momentary exposure to high-power handheld laser devices, which can permanently reduce central vision. While spontaneous closure may be anticipated in some cases, most cases require surgical intervention. Vitrectomy is successful in closing the macular hole along with visual acuity improvement in most of the cases.
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