Long-Term Outcomes following Intravitreal Ranibizumab for Choroidal Neovascularization Related to Nd:YAG Laser Macular Injury: A Case Report

Abstract

Choroidal neovascularization (CNV) secondary to Nd:YAG laser macular injury consists of a rare condition without standardized treatment. Herein, we present the long-term outcomes of a case with a spontaneous closure of a laser-associated macular hole that was followed by late-onset CNV and was successfully treated with intravitreal ranibizumab. A 32-year-old man suffered a macula injury in his right eye after accidental exposure to an 800-nm wave length Nd:YAG laser pulse. Ophthalmological examination demonstrated deterioration in visual acuity along with parafoveal and post-hyaloid hemorrhage. After 1 month, fundoscopy indicated the formation of a full-thickness macular hole. A close observation revealed spontaneous closure of the hole and visual improvement within the next month. One and a half year later, the patient presented with sudden visual distortion, while optical coherence tomography and fluorescein angiography disclosed the development of CNV. The patient was successfully treated with a single intravitreal injection of ranibizumab. The patient’s condition has remained stable during an 8-year follow-up period. In conclusion, laser-induced macular injury consists of an increasingly remarkable condition that may have a profound impact on visual outcomes. Our case provides insight into the potential mechanisms of Nd:YAG laser injury and its complications, indicating that CNV may occur even in the long term, while anti-vascular endothelial growth factor may help maintain stable anatomic and functional outcomes.

Retinal injury from a laser skin resurfacing device during medical tourism: a public health concern

“…While retinal injuries caused by handheld laser pointers are relatively common [ 9 ], there have been fewer reported injuries from cosmetic laser devices [ 2 , 5 , 6 ], and no published cases have resulted from the emerging practice of medical tourism. In the U.S., all laser-based devices sold for human and veterinary use are classified, with users required to adhere to mandatory performance standards and safety regulations set by the U.S. Food and Drug Administration and the Occupational Safety and Health Administration.…”

“…In the U.S., all laser-based devices sold for human and veterinary use are classified, with users required to adhere to mandatory performance standards and safety regulations set by the U.S. Food and Drug Administration and the Occupational Safety and Health Administration. The handheld Q-switched Nd:YAG pulsed laser device used for skin resurfacing in this case typically operates at wavelengths of 800 or 1064 nm, with fluence ranging from 2 to 5 J/cm², which has an energy level capable of inducing retinal burns [ 5 , 6 , 9 ]. It would be categorized as a Class IV laser device in the U.S. and would have necessitated protective eyewear by both operators and patients to prevent laser-induced damage to ocular structures [ 10 , 11 ].…”

“…Although surgical intervention was considered to remove the epiretinal membrane, the identification of choroidal neovascularization prompted the off-label use of the anti-vascular endothelial growth factor agent, bevacizumab. Several previous studies report the off-label use of bevacizumab [ 5 ], aflibercept [ 15 ], or ranibizumab [ 6 ] to manage choroidal neovascularization and associated retinal hemorrhage, which may be more aggressive and rapid in onset compared with those associated with age-related retinal diseases [ 6 ]. This management approach effectively treated the choroidal neovascularization, but, more importantly, the case presented is the first case to illustrate the utility of these agents to dramatically reverse the aggressive epiretinal scar tissue capable of deforming the macula.…”

“…Safety measures required when utilizing laser-based devices include the wearing of safety goggles or placing eye shields over the closed eyelids, as inadequate shielding may expose the ocular tissues to damage from unintentional exposures [ 16 ]. Symptoms of an ocular laser burn include eye pain, redness, light sensitivity, blurred vision, the sudden appearance of new floaters or a scotoma, excessive tearing, or headache [ 5 , 6 , 9 ]. Lack of external signs of damage may lead to an underestimation of intraocular damage, but in the case of any suspected laser-induced ocular injury, immediate referral to an ophthalmologist is indicated [ 16 ].…”

“…Depending on local regulations, lasers in these settings may be operated without proper training or precautions to ensure patient safety [ 4 ]. While those seeking laser skin resurfacing are often counseled on the risk of dermatologic adverse effects [ 1 ], far fewer are warned that ocular tissues are vulnerable to injury by laser radiation [ 5 , 6 ]. Here, we present the case of a woman who suffered a retinal burn resulting in permanent vision loss as a direct result of a laser skin resurfacing procedure at a medical spa in Vietnam.…”