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Gregory D Lee, Caroline R Baumal, David Ryan Lally, Elias Reichel, Jay S Duker; Retinal Injury from Accidental Laser Exposure: Evolution of Changes on SD-OCT and Examination. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6368.
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To evaluate the spectral domain optical coherence tomography (SD-OCT) features following accidental macular retina laser exposure.
Case series of five eyes of three individuals who developed retinal injury secondary to inadvertent laser exposure. All individuals underwent ophthalmologic examination and macular SD-OCT at initial laser exposure and between 4 to 12 months after exposure.
Two of the three individuals were males who sustained bilateral macular damage secondary to class IIIB laser pointer light reflected into a mirror. The third individual was an adult exposed to an occupational laser with monocular macular damage. Two of three patients had a permanent reduction in visual acuity to 20/200 to 20/400 at their last follow up. The development of permanent visual loss was related to location of retinal damage in the central fovea. In all five eyes at initial presentation, SD-OCT demonstrated outer retinal hyperreflectivity extending from the external limiting membrane (ELM) through the photoreceptor layers (inner segment ellipsoid, ISe, and interdigitation zone, IDZ) to the retinal pigment epithelium (RPE). Focal opacification of Henle’s fiber layer (HFL) was apparent arising from the central outer nuclear layer (ONL). The underlying RPE appeared irregular. In all five affected eyes, the nerve fiber layer and inner nuclear layer were unaffected. Clinically the acute lesions appeared to be flat yellow areas with hypopigmented borders. Longitudinal SD-OCT examination performed between 4 to 12 months after exposure revealed some restoration of the ONL and ELM. There was irregularity in the ISe and IDZ areas, suggesting permanent damage to photoreceptors. Clinically, there was RPE clumping in the lesion and attenuation at the lesion borders.
SD-OCT demonstrates longitudinal changes in the retinal anatomy after inadvertent laser exposure. Damage is most prominent in the photoreceptor layers, but may extend from the outer plexiform layer through Henle’s layer to the RPE. In addition to lasers in laboratory or industrial settings, handheld laser pointers available over the internet may not adhere to the ANSI standards recommended for laser pointers and have potential to produce ocular injury.
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