A case of accidental retinal injury by cosmetic laser

Abstract

A 62-year-old Caucasian woman with a 12-month history of progressive paresthesias below the first lumbar level (L1) was hospitalized for rapid onset of ascending sensory impairment to the sixth thoracic level (T6), ataxia, saddle anesthesia, and diminishing central vision. Best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/400 in the left eye. Her BCVA had been 20/25 bilaterally two years prior. Color discrimination was severely diminished at 4/12 Ishihara color plates in the right and 1/12 in the left. Dilated fundus exams showed small flat yellowish deposits limited to wellcircumscribed subfoveal areas of retinal pigment epithelium (RPE) atrophy (Figure 1). There was no optic nerve pallor. The fundus appearance and fluorescein angiogram findings were similar to those described in cases of congenital MMA. 4,5 Full-field electroretinograms revealed mildly reduced scotopic and photopic responses in the left eye.Despite a low normal level of vitamin B12 (298 pg/ml; reference 180-914 pg/ml), the patient's serum methylmalonic acid (0.30 mM/l; reference o0.30 mM/l) and homocysteine (22.2 mM/l; reference 6.2-15.0 mM/l) levels were elevated, consistent with a diagnosis of vitamin B12 deficiency. Furthermore, brain and spinal cord magnetic resonance imaging revealed T2-weighed hyperintensity of the entire dorsal columns, characteristic of vitamin B12 deficiency.The patient was treated with cyanocobalamin injections by the inpatient Neurology service. Six weeks after treatment, her ataxia, paresthesias, as well as bowel and bladder function improved. Color discrimination improved to 8/12 in the right and 5/12 in the left eye.

Observation of changes after peripheral retinal injury by cosmetic laser, using wide-field scanning laser ophthalmoscope

“…Similar to our case, Chen et al [9] reported a peripheral retinal injury that occurred approximately 5 DD below the posterior pole; however, they were only able to report monitoring for 3 days following the injury because of patient loss. As our case was similar to that of Chen et al, [9] we considered changes in hemorrhaging over time and possible onset of retinal detachment.…”

“…[1] There have been recent reports regarding various retinal complications caused by cosmetic laser devices, most of which are limited to the retinal posterior pole. [3–8] Chen et al [9] reported a peripheral retinal injury that occurred 5 disc diameters (DD) below the macula; however, they limited their report to progress monitoring for 3 days following the injury, because of patient loss. We report on a case involving peripheral retinal injury caused by 1064-nm Nd:YAG: neodymium-doped yttrium aluminum garnet.…”

Ocular adverse effects after facial cosmetic procedures: a review of case reports

“…Recent and main complications described were uveitis, pupillary distortion, cataracts, visual field defects, macular hole, iris atrophy, posteriors synechiae, vitreous hemorrhage, and foveal photocoagulation . Lin et al .…”

Alexandrite Laser-Induced Choroidal Neovascularization Successfully Treated With Aflibercept

“…The visual outcome may vary according to the location of the injury. Chen et al recently reported a retinal laser-induced burn associated with BCVA 20/20, despite the remarkable vitreous haemorrhage and retinal edema [7]. Another case report of a laser beam, however, which focused on the macula, caused a scar in the fovea with consequent central scotoma and BCVA 6/60 with no further improvement at an 18-month follow-up examination [8].…”