Foveal haemorrhage from makeshift ‘Lightsaber’: funduscopy and optical coherence tomography findings

Abstract

DESCRIPTIONA 15-year-old boy presented after being attacked by a 'Lightsaber' wielded by his friend. The device in question was a blue laser pointer (450 nm 8000 mW) reflected by his friend off a mirror-the beam caught the patient in the left eye for a mere 1 or 2 s. His vision dropped immediately and he presented the next day with a macular haemorrhage (figure 1) and a vision of 6/60. We treated via observation only and, fortunately, his vision improved slowly over the next 4 weeks: day 7, 6/36; day 14, 6/18 and day 30, 6/12. In the absence of any evidence for an active choroidal neovascular membrane, we felt that intravitreal antivascular endothelial growth factor therapy was not indicated.It is common knowledge that lasers can cause retinal injury, 1 but we would like to share these Figure 1 Fundus photos and optical coherence tomography images capturing the natural history of the foveal haemorrhage following the laser injury.

Sub-inner limiting membrane hemorrhage following a laser show

“…Different treatment options have been used, such as observation 2,11,18 ; however, it requires close monitoring and, the greater the hemorrhage, the slower the reabsorption is, and not all patients regain their visual capacity 19 . The YAG laser allows the drainage of blood into the vitreous cavity and is reabsorbed in an average of 6 weeks.…”

Laser-induced ocular injury: a narrative review

“…Although a large proportion of laserinduced ocular injury improves spontaneously, medical and/ or surgical intervention may be required for complications such as subretinal, intraretinal, subhyaloid, and preretinal Medical laser devices: cosmetic laser procedure, 43 laser removal of skin lesion, 32 laser epilation of eyelid 30 / eyebrow, 29,51 ophthalmic laser application 49,50 Occupational exposure to laser 27 Air flight exposure to laser 39 Recreational exposure to laser 28 Military laser accident 37,38 Corneal injury 43,63 hemorrhage, full-thickness macular hole, and epiretinal membrane and choroidal neovascularization. 7,21,22,28,48,[55][56][57] One case report described rod and cone cells dysfunction leading to diffuse peripheral visual field defect following a diode laser injury. 34 Differential diagnoses of laser-induced retinal injury include retinal dystrophies (eg, Best disease and Stargardt disease) and inflammatory and ischemic retinopathies.…”

Hemorragia submembrana limitante interna secundaria a láser de espectáculos

“…Se han utilizado diferentes opciones de tratamiento, como la observación 2,11,18 ; sin embargo, requiere de una vigilancia estrecha y, a mayor extensión de la hemorragia, tiende a una reabsorción más lenta, además no todos los pacientes recuperan su capacidad visual 19 . El YAG-láser permite que la sangre drene a la cavidad vítrea y se reabsorba en un promedio de 6 semanas.…”