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J Brown, H Zwick, B Lund, BE Stuck; Long Term Assessment Of Visual Function Following Untreated Accidental Laser Induced Macular Hole . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2479.
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Purpose: To evaluate the long-term functional and anatomic results following accidental laser induced macular injury. Methods: A patient with a Nd:YAG laser-induced macular hole was evaluated at baseline, 3 months, 1year and 2 years following injury. Visual acuity, Amsler grid testing, contrast sensitivity, fundus examination, optical coherence tomography (OCT), and indocyanine green (ICG) angiography were performed. Fixational eye movements were recorded using a dual image Purkinje eye tracker. Results: The patient presented with 20/150 visual acuity with vitreous hemorrhage. After the hemorrhage cleared, visual acuity improved to 20/70 at 3 months. He demonstrated a central scotoma on Amsler grid testing, occupying the central three degrees. Fundus examination and OCT revealed a 200-micron full thickness macular hole with characteristic cystoid spaces in the surrounding retina. Indocyanine green angiography identified decreased perfusion at the base of the hole, at the level of the choriocapillaris. The patient elected to defer surgery. At one year, visual acuity improved to 20/40. Contrast sensitivity showed improvement most prominently in the lower and mid spatial frequencies. OCT revealed tissue bridging most of the base of the hole. The hole edges were in closer proximity. The ability to maintain fixation was significantly improved over baseline. At two years, best-corrected visual acuity was 20/30. A small central scotoma was noted on the Amsler grid, occupying the central 1 degree. The patient reported that he achieved his best acuity by fixating just below the target, putting the image above the scotoma. Slit lamp biomicroscopy revealed a more prominent cuff of subretinal fluid and a thin epiretinal membrane on the retinal surface. OCT showed slight enlargement of the macular hole edges with more prominent intraretinal cystoid spaces compared to one year earlier. ICG continued to show lack of perfusion beneath the hole without evidence of neovascularization. Conclusion: Laser induced macular holes can occur following accidental retinal exposure to Nd:YAG laser emissions. Patients with small (<500 microns) macular holes may demonstrate an improvement in visual acuity over time. However, a chronically open hole can result in late progressive retinal atrophy. This patient and other previous patients have shown that late contraction of epiretinal membranes may cause hole enlargement without treatment. The remarkably good visual acuity demonstrated by this patient may reflect photoreceptor reorganization at the new preferred retinal location. Neural reorganization at higher levels may also play a role.
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