Vitrectomy for macular hole following Nd:YAG laser injury

Vitrectomy for a traumatic macular hole caused by cosmetic laser in a beauty salon: A case report

Background

The Nd:YAG laser is widely used in various aspects of work and life. Currently, it has become a popular cosmetic technique in beauty salons. The laser can be dangerous when it flashes into people's eyes.

Case presentation

A 34-year-old female sustained a 1064-nm Q-switched Nd:YAG laser injury to her left eye. One month after the injury, she presented to our clinic with best-corrected visual acuity (BCVA) of 20/250 and a full-thickness macular hole on the optical coherence tomography (OCT). The patient received pars plana vitrectomy, internal limiting membrane peeling and sterile air injection 3 months after the injury. OCT showed closure of the hole 9 days postoperatively. After a 3-month follow-up, her BCVA improved to 20/100.

Conclusions

This case report comprehensively introduces the whole progression of a cosmetic laser-induced macular hole from formation to recovery. Due to the potential threats of the laser and its irreversible damage to the retina and choroid, sufficient education should be given before performing any laser devices, especially those without professional knowledge.

Full Thickness Macular Hole in Aesthetician Occurring Due to Accidental Self-exposure to Cosmetic Laser Machine Trying to Take Special Precautions Against COVID-19

A 25-year-old aesthetician was operating Q-switch pulse (SPECTRA) cosmetic laser machine of 1,064 nm wavelength, for the purpose of skin bleaching. The probe suddenly slipped over the plastic sheet that had been placed to avoid COVID-19 exposure after which she complained of sudden loss of vision. She was diagnosed as having vitreous hemorrhage in her right eye and was treated conservatively for one month. She then complained of central scotoma and was diagnosed to have developed a full-thickness macular hole, for which she was advised vitrectomy surgery. The purpose of this case report is to emphasize the importance of taking precautions during the COVID-19 era and while doing that making sure how to handle the machines so as not to inflict any accidental injury to the operating physician. Macular Holes following skin bleaching with Nd:YAG laser occurring in operating aesthetician is rare as compared to that occurring in the patients.

A case of Nd:YAG laser-induced traumatic macular hole with good visual prognosis after vitrectomy with inverted internal limiting membrane technique

Purpose

To report an accidental case of traumatic macular hole caused by Nd:YAG laser in a dermatology clinic.

Observations

A 24-year-old woman sustained a laser injury to her right eye while practicing a dermatologic treatment using a Nd:YAG laser without wearing protective goggles. She noticed sudden-onset and progressing visual loss in her right eye and consulted an ophthalmologist 2 days after injury. The best-corrected visual acuity (BCVA) of her right eye decreased to 20/133. Fundus examination showed white parafoveal flecks with a central retinal hemorrhage and underlying serous retinal detachment. The retinal sensitivity in this lesion deteriorated. Two weeks later, a full-thickness macular hole (FTMH) developed in the affected eye. She was referred to Nagoya City University Hospital where the laser damage described was observed. The BCVA was 20/67. She underwent pars plana vitrectomy performed using the inverted internal limiting membrane (ILM) flap technique and gas tamponade. One week postoperatively, the FTMH closed, the BCVA in her right eye improved to 20/50, and the retinal sensitivity in the macular area mostly improved. The BCVA gradually improved and reached 20/25 9 months after the injury.

Conclusions and importance

Protective goggles must be worn when using an Nd:YAG laser in the laboratory or clinical setting. In the unfortunate event of a FTMH, early vitrectomy with an inverted ILM flap technique can be helpful to achieve a good visual prognosis.

SPONTANEOUS CLOSURE OF A MACULAR HOLE RESULTING FROM YAG LASER CAPSULOTOMY IN A 13-YEAR-OLD GIRL

PURPOSE

To describe the novel finding of spontaneous resolution of a full-thickness macular hole resulting from YAG laser capsulotomy in a 13-year-old girl with previous history of retinal detachment repair and cataract surgery.

METHODS

A 13-year-old girl who had developed a macular hole after YAG laser was noted to have spontaneous resolution of the macular hole at 2-week follow-up visit with concurrent increase in visual acuity. Institutional review board was not applicable for this case.

RESULTS

Spontaneous resolution of a YAG laser-induced macular hole in a pediatric patient.

CONCLUSION

This is a novel report in a pediatric patient of spontaneous resolution of a full-thickness macular hole induced by YAG laser capsulotomy. If a macular hole is noted after YAG capsulotomy, consideration should be given to initial close observation rather than surgical intervention as spontaneous resolution may occur.

Internal limiting membrane peeling without vitrectomy for laser-induced macular holes in two children

PURPOSE

To describe a technique of internal limiting membrane (ILM) peeling without vitrectomy for the treatment of laser-induced macular holes in two children.

METHODS

ILM peeling was performed under the vitreous hyaloid, and the vitreous was retained. Slit lamp and optical coherence tomographic examinations were performed before and after surgery.

RESULTS

Macular holes were closed with different patterns at different time in the two patients, while visual acuity improved significantly in both of them eventually.

CONCLUSION

The technique of ILM peeling in the absence of vitrectomy can promote the closure of laser-induced macular holes and minimize the surgical procedure, with few vitrectomy complications in pediatric patients. The closure pattern may vary on account of different injury sources and extents.

Inverted internal limiting membrane flap technique and an autologous platelet concentrate to treat an Nd: YAG laser-induced macular hole: A case report

RATIONALE

Nd:YAG laser-induced macular holes (MHs) feature more extensive anatomical defects and worse functional outcomes than idiopathic MHs. Although new treatment options for large refractory MHs have been suggested, the current literature on Nd:YAG laser-induced MHs suggests only conventional pars plana vitrectomy combined with internal limiting membrane (ILM) peeling, which is the same treatment as for idiopathic MHs.

PATIENT CONCERNS

A 40-year-old dermatologist was referred to us because of a sudden decrease in visual acuity following exposure to a floor-tile-reflected single-shot Nd:YAG laser beam while not wearing protective goggles.

DIAGNOSES

An Nd:YAG laser-induced MH was diagnosed based on fundoscopy and optical coherence tomography (OCT).

INTERVENTIONS

Pars plana vitrectomy using an inverted ILM flap technique and autologous platelet concentrate (APC) was performed.

OUTCOMES

Postoperative spectral domain OCT and en-face OCT showed "U-shaped" closure of the MH and a decreased ellipsoid zone defect, while the best-corrected visual acuity improved from 20/500 to 20/25.

LESSONS

The inverted ILM flap technique combined with APC is an effective option to achieve successful MH closure and visual improvement in patients with an Nd:YAG laser-induced MH.

Assessment of Vitreous Structure and Visual Function after Neodymium:Yttrium-Aluminum-Garnet Laser Vitreolysis

PURPOSE

Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser treatment is performed on vitreous floaters, but studies of structural and functional effects with objective outcome measures are lacking. This study evaluated Nd:YAG laser effects by comparing participants with vitreous floaters who previously underwent laser treatment with untreated control participants and healthy persons without vitreous floaters using quantitative ultrasonography to evaluate vitreous structure and by measuring visual acuity and contrast sensitivity function to assess vision.

DESIGN

Retrospective, comparative study.

PARTICIPANTS

One eye was enrolled for each of 132 participants: 35 control participants without vitreous floaters, 59 participants with untreated vitreous floaters, and 38 participants with vitreous floaters previously Nd:YAG-treated. Of these, 25 were dissatisfied and sought vitrectomy; 13 were satisfied with observation.

METHODS

The 39-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-39) to assess participant visual well-being, quantitative ultrasonography (QUS) to measure vitreous echodensity, and best-corrected visual acuity (BCVA) and contrast sensitivity function (CSF) to evaluate vision.

MAIN OUTCOME MEASURES

Results of NEI-VFQ-39, QUS, BCVA, and CSF.

RESULTS

Compared with control participants without vitreous floaters, participants with untreated vitreous floaters showed worse NEI-VFQ-39 results, 57% greater vitreous echodensity, and significant (130%) CSF degradation (P < 0.001 for each). Compared with untreated eyes with vitreous floaters, Nd:YAG-treated eyes had 23% less vitreous echodensity (P < 0.001), but no differences in NEI-VFQ-39 (P = 0.51), BCVA (P = 0.42), and CSF (P = 0.17) results. Of 38 participants with vitreous floaters who previously were treated with Nd:YAG, 25 were dissatisfied and seeking vitrectomy, whereas 13 were satisfied with observation. Participants seeking vitrectomy showed 24% greater vitreous echodensity (P = 0.018) and 52% worse CSF (P = 0.006). Multivariate linear regression models confirmed these findings.

CONCLUSIONS

As a group, participants previously treated with Nd:YAG laser for bothersome vitreous floaters showed less dense vitreous, but similar visual function as untreated control participants with vitreous floaters. Because some treated eyes showed less dense vitreous and better visual function than those of untreated control participants, a prospective randomized study of Nd:YAG laser treatment of vitreous is warranted, using uniform laser treatment parameters and objective quantitative outcome measures.