Macular hemorrhage after laser exposure and cannabinoid intake during a disco party

A retrospective analysis of presentation and outcomes in a cluster outbreak of non-occupational laser exposure retinopathy

OBJECTIVE

To investigate and describe the clinical presentation and outcomes of a case series with possible retinal laser injury following recreational laser shows and assess their attributability to laser exposure.

DESIGN

Multi-center case series.

SUBJECTS

All consecutive eyes with reported laser exposure from recreational laser show and confirmed retinal injury presenting between May 2022 and April 2023.

METHODS

Data were collected including demographics, details of laser exposure, prior ophthalmic or significant past medical history, clinical presentation including visual acuity, fundus photography, optical coherence tomography (OCT) or fundus fluorescein angiography (FFA) if available, treatment used, and follow-up and final outcomes in terms of visual acuity and complications, if any. Fundus photographs and OCT images were analyzed.

MAIN OUTCOME MEASURES

Demographics of the cohort, presenting and final visual acuity, morphology of retinal injury on fundus photographs and OCT images, complications if any, regression analysis to test connections to known events.

RESULTS

The study included a total of 51 eyes of 51 patients, all of whom reported exposure to recreational laser shows. The mean LogMAR visual acuity at presentation was 1183 (SD 0.50). All the eyes had premacular hemorrhage of mean size 1.90 disc diameters (SD 1.29), while a dot of retinal whitening ("white spot") was observed within the parafoveal area in 13 eyes (32.5%). Laser hyaloidotomy was performed in 54.9% of eyes, while 45.10% were managed conservatively. The majority of eyes [22, 78.57%] showed complete drainage immediately after hyaloidotomy, while partial drainage occurred in six eyes (21.43%). Only two eyes (4.26%) exhibited small residual hemorrhage at the end of the three-month period. Final mean LogMAR visual acuity was 0.123 (SD 0.20). Complications included RPE changes and epiretinal membrane formation. The incidence of cases correlated well with significant cultural events.

CONCLUSION

The presentation in all eyes was strongly suggestive of laser injury. Even though the outcomes were favorable, complications were not uncommon. We strongly recommend the immediate introduction of regulatory measures and establishment of a monitoring framework for laser shows in India. We propose referring to these injuries as "non-occupational laser exposure retinopathy".

An outbreak of subhyaloid hemorrhage after accidental laser exposure during an Indian festival

PURPOSE

To report the clinical manifestations and outcomes of patients who experienced retinal damage due to accidental laser exposure during a festival in Kolhapur, Maharashtra.

METHODS

Consecutive patients who presented with sudden loss of vision following exposure to laser lights during a religious Indian festival (Ganapati festival) on the same day (9 September 2022) at the same location (idol visarjan procession) were identified from the medical records of various eye hospitals in Kolhapur district of Maharashtra. Eyes with persistent subhyaloid hemorrhage (SHH) were taken up for neodymium-doped yttrium aluminum garnet (Nd: YAG) posterior hyaloidotomy. Patients were examined at weekly intervals up to 1 month.

RESULTS

Thirty-four eyes of 34 men were identified with age ranging from 18 to 27 years. The mean duration of exposure to the laser projections was 4.9 ± 1.7 h, and the mean distance from the laser source was 7.3 ± 2.7 feet. All presented with SHH involving the macula. SHH had a median size of 3 disc diameters or larger in 30 eyes (88%), and 29 (97%) of these required hyaloidotomy while one patient underwent pars plana vitrectomy. The mean visual acuity improved from 1.45 ± 0.5 log of minimum angle of resolution (logMAR; 20/560 Snellen) to 0.11 ± 0.19 logMAR (20/25 Snellen) (P < 0.001). One eye showed full-thickness macular hole with visual acuity of 20/200.

CONCLUSION

We report a large number of patients experiencing laser-induced SHH, resembling an outbreak, due to exposure to a malfunctioning high-powered recreational laser during a religious festival.