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Lu Q, Sun M, Cao J, Wang W, Wang H, Gao Y, Wang Y, Guo X, Yang W, Wang H. Acupuncture is an effective therapy for macular damage: A case report. Medicine (Baltimore) 2023; 102:e34735. [PMID: 37653781 PMCID: PMC10470758 DOI: 10.1097/md.0000000000034735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023] Open
Abstract
RATIONALE Many factors can contribute to the development of macular injury, which results in vision loss as a result of a disease. Heredity, age, underlying eye illness, internal eye surgery, or eye trauma can all cause it. A safer alternative to current therapies for macular degeneration is urgently needed since they all induce ocular irritation and postoperative recurrence as well as a host of other adverse effects. PATIENT CONCERNS A 12-year-old girl was the patient. A laser pen burnt her right eye. There was a spot and a shadow in the middle of her right eye's visual field. DIAGNOSES Macular degeneration. INTERVENTIONS Given the patient's age, we opted out of medicine and instead used acupuncture as a symptomatic treatment. OUTCOMES Two months after therapy concluded, optical coherence tomography result report indicate that the macula region of the right eye is better than it was previously. The corrected visual acuity of the right eye recovered from 0.25 to 1.0, and the clinical accompanying symptoms of the right eye disappeared. LESSONS No additional medication or surgical procedure was employed in this instance. We treated the macular damage with acupuncture, which relieved the patient's clinical symptoms and had no adverse effects. This demonstrates that acupuncture may be beneficial in treating ophthalmopathy in this direction.
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Affiliation(s)
- Qi Lu
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Mengmeng Sun
- Changchun University of Chinese Medicine, Changchun, China
| | - Jinfeng Cao
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Weizheng Wang
- Department of Acupuncture and Tuina, The Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Haili Wang
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Yu Gao
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Ying Wang
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Xiaole Guo
- Department of Acupuncture and Tuina, The Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Weiwan Yang
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Hongfeng Wang
- Changchun University of Chinese Medicine, Changchun, China
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Wiest MRJ, Gunzinger JM, Hamann T, Fasler K, Said S, Bajka A, Muth DR, Barthelmes D, Blaser F, Zweifel SA. Natural Course of Solar and Laser-Associated Retinal and Macular Injuries at a Primary Care Hospital in Switzerland. Klin Monbl Augenheilkd 2023; 240:516-521. [PMID: 37164408 DOI: 10.1055/a-2021-7724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Solar and laser-associated retinopathies are rare occurrences. The two retinopathies are both photo-induced but differ in the involved intensity and duration of exposure. The purpose of this study was to evaluate the clinical features and natural course of these two entities, with a focus on the changes in the outer retina over time. PATIENTS AND METHODS This retrospective analysis assessed patients with solar or laser maculopathy seen at the Department of Ophthalmology of the University Hospital Zurich in Switzerland over the last 10 years. Visual acuity (VA; Snellen) and optical coherence tomography (OCT) findings were reviewed and analyzed at baseline and last follow-up visit. Areas of damaged outer retina, identified on en face OCT images as hyporeflective areas, were tagged and compared between visits. Descriptive analysis was performed by calculating mean values ± standard deviation (SD). Statistical evaluation was done using the Wilcoxon signed rank test. A p value < 0.05 was considered statistically significant. RESULTS Five patients with solar retinopathy and six patients with laser-associated retinopathy were identified. In the solar retinopathy group, mean VA at baseline was 0.80 (SD ± 0.37) and improved to 0.90 (SD ± 0.36). This was not statistically significant (p = 0.066). In the laser-associated retinopathy group, mean VA at baseline was 0.89 (SD ± 0.18) and improved to 1.03 (SD ± 0.09), which was not statistically significant either (p = 0.063). At baseline, in OCT cross-sections, initial changes were observed in the interdigitation, myoid, and ellipsoid zone, as well as the outer nuclear layer and the Henle fiber layer. At follow-up, most cases presented an alteration in the residual ellipsoid zone, with the degree of the aforementioned alterations depending on the size of the initial defect. A decrease of the hyporeflective alterations measured in en face OCT scans was observed in both groups but was only statistically significant in the laser-associated retinopathy group (p = 0.018 versus p = 0.172). CONCLUSIONS OCT can help to detect and monitor solar and laser-associated retinal injuries. Most injuries are minor, with good functional restitution. Minor changes in the ellipsoid zone often persist, even in cases with full visual recovery.
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Affiliation(s)
| | | | - Timothy Hamann
- Ophthalmology, University Hospital of Zurich, Zurich, Switzerland
| | - Katrin Fasler
- Ophthalmology, University Hospital of Zurich, Zurich, Switzerland
| | - Sadiq Said
- Ophthalmology, University Hospital of Zurich, Zurich, Switzerland
| | - Anahita Bajka
- Ophthalmology, University Hospital of Zurich, Zurich, Switzerland
| | | | | | - Frank Blaser
- Ophthalmology, University Hospital of Zurich, Zurich, Switzerland
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Reid G, Shirley K, Gamble R, George S, O'Gallagher M, Kearney J, McLoone E. Macular injuries secondary to handheld lasers in a paediatric population-clinical characteristics and indicators of visual impact. Eye (Lond) 2023; 37:176-182. [PMID: 35087213 PMCID: PMC9829854 DOI: 10.1038/s41433-021-01916-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 12/06/2021] [Accepted: 12/20/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND/OBJECTIVES Aim to identify incidence and prevalence of laser-induced retinal injuries in the Northern Ireland paediatric population and to determine negative clinical and OCT indicators in relation to visual acuity. SUBJECTS/METHODS A retrospective analysis was conducted of retinal injuries secondary to handheld laser pens over a 6-year time period with presenting and final visual acuity (VA), laser source and circumstances of the injury recorded. Fundus photographs and OCT images for each case were also collated. RESULTS Sixty-five patients (74 eyes) were identified of which 72% were male and mean age was 11.6 years. 40% of patients were symptomatic. Mean presenting VA was 0.16 LogMAR. VA was ≤0.30 LogMAR in 20 eyes (27%) at presentation. Features which impacted VA to a significant level were foveolar location, diffuse morphology, ELM and BM/RPE/IDZ disruption and ORH presence on presenting OCT images. ORHs or ELM disruption resulted in a significant risk ratio of 3.5 (p = 0.002) and 3.4 (p = <0.001) respectively. Mean presenting VA was demonstrated to improve during follow-up from 0.36 to 0.22 LogMAR (n = 20, p = 0.03). When VA was ≤0.30 LogMAR at presentation, mean presenting VA improved from 0.56 to 0.29 LogMAR (p < 0.01) with 58% of eyes improving to a VA of better than 0.30 LogMAR. CONCLUSIONS The overall visual loss from macular laser injuries was low and we have identified features on retinal imaging that significantly impact presenting VA. When VA is affected following macular laser injury there is evidence of recovery with >50% of those presenting with VA ≤ 0.30 LogMAR improving to better than 0.30 LogMAR.
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Affiliation(s)
- Gerard Reid
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast, UK.
| | - Katherine Shirley
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast, UK
| | - Rachel Gamble
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast, UK
| | - Sonia George
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast, UK
| | - Michael O'Gallagher
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast, UK
| | - Jane Kearney
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast, UK
| | - Eibhlin McLoone
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast, UK
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Gauldin D, Ahmad KT, Ferguson S, Uwaydat SH. Exposure of Contralateral Eyes to Laser Radiation during Retinal Photocoagulation. Curr Eye Res 2021; 46:1424-1427. [PMID: 33615938 DOI: 10.1080/02713683.2021.1884729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose/Aim: To investigate the risk of laser damage to the unprotected fellow eye of patients undergoing laser retinal photocoagulation with 532 nm diode pumped solid-state laser.Materials and Methods: A mannequin head was fitted with a Vega laser energy meter and PD10 photodiode laser measurement sensor. Lowest measurable energy for this sensor is 2 nJ at 900 nm. Simulated retinal laser treatments were performed on a model eye placed in one of the sockets of the mannequin head, while the laser sensor was placed in the opposite socket. Four simulated sessions of retinal photocoagulation were performed utilizing both slit lamp and indirect laser delivery systems. Each consisted of 10 applications of the laser directly into the model eye and 10 applications near but not directly into the sensor, utilizing various treatment settings.Results: No laser exposure was detected in the model eye during simulated retinal photocoagulation sessions aimed directly into the treatment eye. When the laser application was aimed near the sensor, no laser exposure was detected at the standard setting, however, in all sessions conducted at the higher laser power setting, the mean exposure detected was <6 µJConclusions: Laser exposure in the unprotected contralateral eye of patients undergoing retinal laser treatment with the PASCAL laser machine under standard PRP settings was found to be miniscule. However, we still recommend laser safety eyewear for the untreated eye to provide protection in the event of direct accidental laser exposure from surgeon error or laser malfunction, in accordance with the most current laser safety guidelines.
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Affiliation(s)
- Donald Gauldin
- Department of Ophthalmology, Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kinza T Ahmad
- Department of Ophthalmology, Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Scott Ferguson
- Department of Ophthalmology, Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sami H Uwaydat
- Department of Ophthalmology, Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Bhavsar KV, Michel Z, Greenwald M, Cunningham ET, Freund KB. Retinal injury from handheld lasers: a review. Surv Ophthalmol 2020; 66:231-260. [PMID: 32628946 DOI: 10.1016/j.survophthal.2020.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 11/24/2022]
Abstract
Retinal photic injury induced by handheld lasers is a burgeoning public health concern due to the wider accessibility of high-powered devices. Retinal damage from thermal energy can cause potentially severe and permanent vision loss in children and young adults who are particularly vulnerable because of comorbid behavioral, learning, and psychiatric impairments. Understanding the spectrum of specific clinical and imaging features of such laser injuries aids in prompt and accurate diagnosis. Multimodal retinal imaging is important for the identification of the outer retinal abnormalities that characterize this condition. We reviewed 171 reported cases in the English and non-English language literature published from 1999, when handheld laser injury was first described, to December, 2018. Risk factors, demographic and clinical characteristics, as well as multimodal imaging findings, were collected and summarized. These findings both provide insights for public health awareness and guide areas of future investigation.
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Affiliation(s)
- Kavita V Bhavsar
- Casey Eye Institute, Oregon Health & Science` University, Portland, OR, USA; Portland VA Healthcare System, Portland, OR, USA.
| | - Zachary Michel
- Casey Eye Institute, Oregon Health & Science` University, Portland, OR, USA
| | - Miles Greenwald
- Casey Eye Institute, Oregon Health & Science` University, Portland, OR, USA
| | - Emmett T Cunningham
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA; The Department of Ophthalmology, Stanford University School of Medicine, San Francisco, CA, USA; The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, CA, USA; West Coast Retina Medical Group, San Francisco, CA, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University Langone Medical Center, New York, NY, USA; Department of Ophthalmology, Columbia University, New York, NY, USA
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6
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Zhu I, Mieler WF, Francis AW. A Mysterious Central Scotoma in a Teenage Male Patient. JAMA Ophthalmol 2020; 138:414-415. [DOI: 10.1001/jamaophthalmol.2019.5383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ivy Zhu
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago
| | - William F. Mieler
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago
| | - Andrew W. Francis
- Division of Ophthalmology, NorthShore University HealthSystem, Evanston, Illinois
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
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En Face Optical Coherence Tomography Imaging Ellipsoid Zone Regeneration in Laser-Induced and Solar Maculopathies. Case Rep Ophthalmol Med 2019; 2019:3849871. [PMID: 31885977 PMCID: PMC6925683 DOI: 10.1155/2019/3849871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/15/2019] [Indexed: 11/17/2022] Open
Abstract
The purpose of the study was to analyze imaging findings in spectral domain en face optical coherence tomography (SD OCT) in patients with laser-induced and solar maculopathies focusing on the possible regeneration of the ellipsoid zone. In a retrospective case series of 3 patients (4 eyes) with solar maculopathy and 2 patients (3 eyes) with laser-induced maculopathy who underwent a comprehensive ocular examination, ellipsoid zone (EZ) was segmented from SD OCT data. Evaluation of EZ in en face OCT revealed a hyporeflective lesion surrounded by a hyperreflective border. The area of EZ alteration was measured manually in en face OCT. All patients showed partial EZ regeneration. Mean EZ alteration decreased from 0.12 mm2 (range: 0.05-0.32) at baseline to 0.07 mm2 (range: 0.01-0.22) at last follow-up (p = 0.018, mean follow-up: 372 days; range: 115-592). Mean best visual acuity (BVA) improved from 20/36 at baseline to 20/30 (p = 0.018). In conclusion, en face OCT imaging clearly delineated the area of EZ alteration in patients with laser-induced and solar maculopathies. Follow-up showed significant reformation of the EZ as well as improvement of BVA.
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8
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Linton E, Walkden A, Steeples LR, Bhargava A, Williams C, Bailey C, Quhill FM, Kelly SP. Retinal burns from laser pointers: a risk in children with behavioural problems. Eye (Lond) 2019; 33:492-504. [PMID: 30546136 PMCID: PMC6460723 DOI: 10.1038/s41433-018-0276-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/21/2018] [Accepted: 11/04/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To explore self-inflicted retinal burns from laser pointers in children. METHODS Literature review of laser pointer retinal injuries in childhood and online survey of UK Consultant Ophthalmologists. A cohort of local children with self-inflicted injury is described. The matter is topical. We review progress in recent legislation and policy change in the UK. RESULTS Four of 77 case reports of laser burns in childhood analysed reported psychological or behavioural issues. Three of four children in our cohort had such issues. Delay in diagnosis occurred in two of our patients. Structural retinal damage persisted for over 12 months in all four children (seven eyes). Our survey of UK ophthalmologists found 159 cases of injury (85% male), 80% under 20 years of age. The majority of the laser pointers were purchased online. Many patients (36%) suffered moderate vision loss (6/18 to 6/60 Snellen), while 17% (at least 11 patients) suffered severe vision loss (<6/60 Snellen). CONCLUSION We highlight the risk of macular damage and vision loss from handheld lasers specifically in children with behavioural, learning or mental health issues. The diagnosis may be difficult or delayed in such children. In children with uncertain macular changes, ophthalmologists should explore the history for possible instances of exposure to handheld lasers pointers. Regulatory authorities and manufacturers of handheld lasers need to be aware of the risk to children. Furthermore, there is a need to better inform parents, carers and teachers of the risk of ocular self-injury from such lasers pointers.
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Affiliation(s)
- E Linton
- Department of Ophthalmology, Bolton Hospitals NHS Foundation Trust, Bolton, UK
| | - A Walkden
- Department of Ophthalmology, Lancashire Teaching Hospitals NHS Foundation Hospital, Preston, UK
| | - L R Steeples
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - A Bhargava
- Department of Ophthalmology, Lancashire Teaching Hospitals NHS Foundation Hospital, Preston, UK
| | - C Williams
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - C Bailey
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - F M Quhill
- Department of Ophthalmology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S P Kelly
- Department of Ophthalmology, Bolton Hospitals NHS Foundation Trust, Bolton, UK.
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Commiskey PW, Heisel CJ, Paulus YM. Non-Therapeutic Laser Retinal Injury. INTERNATIONAL JOURNAL OF OPHTHALMIC RESEARCH 2019; 5:321-335. [PMID: 32923732 PMCID: PMC7486027 DOI: 10.17554/j.issn.2409-5680.2019.05.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND: As lasers have become an increasingly important component of commercial, industrial, military, and medical applications, reported incidents of non-therapeutic laser eye injuries have increased. The retina is particularly vulnerable due to the focusing power and optical transparency of the eye. Continued innovations in laser technology will likely mean that lasers will play an increasingly important and ubiquitous role throughout the world. Critical evaluation should thus be paid to ensure that non-therapeutic injuries are minimized, recognized, and treated appropriately. METHODS: A comprehensive literature review on the PubMed database was conducted to present case reports and case series representative of the variety of laser eye injuries in different injury circumstances, tissue types, and biological damage mechanisms. RESULTS: A general summary of non-therapeutic laser retina injuries is presented, including information about growth of the industry, increasingly accessible online markets, inconsistent international regulation, laser classifications, laser wavelengths, and laser power, mechanisms of tissue injury, and a demonstration of the variety of settings in which injury may occur. Finally, 68 cases found in the literature are summarized to illustrate the presentations and outcomes of these patients. CONCLUSIONS: As non-therapeutic laser eye injuries increase in frequency, there is a greater need for public health, policy, diagnosis, and treatment of these types of injuries.
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Affiliation(s)
- Patrick W Commiskey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, the United State
| | - Curtis J Heisel
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, the United State
| | - Yannis M Paulus
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, the United State.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, the United State
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10
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Jolly R, Arjunan M, Theodorou M, Dahlmann-Noor AH. Eye injuries in children - incidence and outcomes: An observational study at a dedicated children's eye casualty. Eur J Ophthalmol 2018; 29:499-503. [PMID: 30270661 DOI: 10.1177/1120672118803512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Trauma is an important cause of visual loss in children and may affect their quality of life. Prevention and legislation can reduce the incidence of trauma, and appropriate and timely treatment can improve prognosis. We aimed to describe incidence of eye injuries in children and the adherence to national and local management guidelines. METHODS Retrospective service evaluation at a tertiary hospital (Moorfields Eye Hospital, London, UK) which operates a dedicated children's eye casualty. The electronic patient administration system and electronic patient record system (Openeyes) were used to identify children who presented with eye injuries between January 2015 and December 2015. RESULTS Of 2397 first-time attendances to our children's casualty, 508 were for injuries (estimated incidence 21.1%, 95% confidence interval: 19.5%-22.7%). Mean age at presentation was 7.51 (standard deviation: 7.97) years; boys were more commonly affected than girls (69%). The most common injury was corneal abrasion, followed by blunt and chemical injury; severe injuries such as penetrating trauma were rare. Injuries were sustained mostly during play or sports. Two children sustained permanent loss of vision in the affected eye. CONCLUSION Our findings are comparable to other published reports. Adherence to management guidelines is high, but documentation of advice given to families can be improved. Regular training of staff and collaboration with organisations outside the hospital can increase awareness of eye injuries in children.
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Affiliation(s)
| | | | - Maria Theodorou
- Moorfields Eye Hospital, London, UK.,NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Annegret H Dahlmann-Noor
- Moorfields Eye Hospital, London, UK.,NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
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11
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Mtanes K, Mimouni M, Zayit-Soudry S. Laser Pointer-Induced Maculopathy: More Than Meets the Eye. J Pediatr Ophthalmol Strabismus 2018; 55:312-318. [PMID: 29913024 DOI: 10.3928/01913913-20180405-01] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 12/20/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the clinical findings in patients with laser-induced retinal injury. METHODS Consecutive patients presenting to a tertiary center between January 2014 and December 2015 following inadvertent ocular exposure to a laser pointer were included. Evaluation included a full ophthalmic examination and spectral-domain optical coherence tomography (SD-OCT). RESULTS Seven young patients (8 eyes) were identified. Their mean age was 18.7 years (median: 16 years; range: 12 to 36 years). In most cases, patients were exposed for several seconds to a 5-mW green laser. At presentation, all patients complained of a central/paracentral scotoma. Snellen best corrected visual acuity (BCVA) at presentation ranged from counting fingers to 6/6. In 5 eyes, a round, well-defined deep yellowish-orange discoloration at the level of the retinal pigment epithelium in the foveola, ranging from 150 to 350 μm in diameter, was noted on ophthalmoscopic examination. Additional findings were macular subhyaloid hemorrhage in 2 eyes and a full-thickness macular hole with cystoid macular edema in 1 eye. In all cases, baseline SD-OCT revealed disruption involving the photoreceptor inner segment/outer segment junction/ellipsoid zone band, and extended toward the inner aspect of the retinal pigment epithelium band, ranging from focal interruption to extensive full-thickness macular hole. All patients received oral corticosteroid treatment with prednisone (0.5 to 1 mg/kg). Follow-up ranged between 2 and 12 months. Over time, improvement in visual acuity to 6/8 and 6/6 was noted in all eyes but one, which remained poor at counting fingers from 2 meters. The visual improvement was associated with complete or near-complete restoration of the integrity of macular structure noted on SDOCT. CONCLUSIONS Commercial handheld laser pointers may inflict notable macular injury and damage vision permanently. Although good visual recovery was often noted, access to commercially available laser devices is potentially hazardous, especially to minors, and public awareness should be raised. [J Pediatr Ophthalmol Strabismus. 2018;55(5):312-318.].
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12
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Bulbusperforation eines 7‑jährigen Kindes durch das „Must-Have Office Toy 2017“. Ophthalmologe 2018; 115:231-234. [DOI: 10.1007/s00347-017-0603-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Alda J, Gómez Sanz F, González Martín-Moro J. Laser pointer maculopathy. A new public health problem? ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2017; 92:1-3. [PMID: 27746065 DOI: 10.1016/j.oftal.2016.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/05/2016] [Accepted: 09/05/2016] [Indexed: 06/06/2023]
Affiliation(s)
- J Alda
- Facultad de Óptica y Optometría, Universidad Complutense de Madrid, Madrid, España.
| | - F Gómez Sanz
- Facultad de Óptica y Optometría, Universidad Complutense de Madrid, Madrid, España; Servicio de Oftalmología, Hospital Universitario del Henares, Coslada, Madrid, España
| | - J González Martín-Moro
- Servicio de Oftalmología, Hospital Universitario del Henares, Coslada, Madrid, España; Universidad Francisco de Vitoria, Madrid, España
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14
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Response to 'Comment on 'Toy' laser macular burns in children: 12-month update'. Eye (Lond) 2016; 31:663-664. [PMID: 27834961 DOI: 10.1038/eye.2016.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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15
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Response to 'Toy' laser macular burns in children: 12-month update. Eye (Lond) 2016; 31:662-663. [PMID: 27834963 DOI: 10.1038/eye.2016.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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16
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Raoof N, Bradley P, Theodorou M, Moore AT, Michaelides M. The New Pretender: A Large UK Case Series of Retinal Injuries in Children Secondary to Handheld Lasers. Am J Ophthalmol 2016; 171:88-94. [PMID: 27590121 DOI: 10.1016/j.ajo.2016.08.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/10/2016] [Accepted: 08/20/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE To characterize a large single-center series of retinal injuries in children secondary to handheld laser devices, with emphasis on potential prognostic factors. DESIGN Retrospective case series. METHODS Sixteen children (24 eyes) with retinal injuries secondary to handheld lasers were identified from our electronic patient record system. Case notes, digital fundus photography, and spectral-domain optical coherence tomography images were reviewed. RESULTS The mean age of affected children was 12.7 years (range 9-16 years), with 12 male and 4 female subjects. Mean follow up was 5.4 months (range 1-23 months). Five children (31%) were referred as suspected retinal dystrophies. The mean logMAR visual acuity at presentation was 0.30 (20/40) (range -0.20 [20/12.5] to 1.6 [20/800]). Eleven children (69%; 15 eyes) had "mild" injuries with focal retinal disruption confined to the photoreceptor and ellipsoid layers; such injuries were associated with a better prognosis, the mean visual acuity at presentation being 0.10 (20/25). "Moderate" injuries were seen in 3 eyes of 2 children, with retinal disruption confined to the outer retinal layer but diffuse rather than focal in nature. Three patients (4 eyes) had "severe" injuries, with subfoveal outer retinal architecture loss and overlying hyperreflective material in inner retinal layers. CONCLUSION Retinal injuries secondary to handheld laser devices may be difficult to diagnose and are likely underreported. It is important that such data are in the public domain, so regulatory authorities recognize the importance of laser retinopathy as an avoidable cause of childhood visual impairment and take steps to minimize the incidence and impact of laser injuries.
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Affiliation(s)
- Naz Raoof
- Department of Ophthalmology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Patrick Bradley
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Maria Theodorou
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Anthony T Moore
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; Ophthalmology Department, UCSF School of Medicine, Koret Vision Centre, San Francisco, California
| | - Michel Michaelides
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; University College London Institute of Ophthalmology, London, United Kingdom.
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Sánchez-Barahona C, González-Martín-Moro J, Zarallo-Gallardo J, Lozano Escobar I, Cobo-Soriano R. Early changes in optic coherence tomography in a child with laser pointer maculopathy. ACTA ACUST UNITED AC 2016; 92:33-36. [PMID: 27542521 DOI: 10.1016/j.oftal.2016.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
Abstract
CASE REPORT A 9-year-old boy referred due to visual loss in his right eye after playing with a laser pointer. In the first visit (12hours later) visual acuity (VA) was 0.15. A hypopigmented lesion was present in the fovea, and optic coherence tomography (OCT) showed vertical hyper-reflective bands. In the last visit (6 months later), VA had improved to 0.5, and OCT showed a well-defined area of outer retinal layer disruption. DISCUSSION An inadequate use of laser pointers can induce severe and permanent visual loss.
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Affiliation(s)
- C Sánchez-Barahona
- Servicio de Oftalmología, Hospital del Henares, Coslada, Madrid, España.
| | - J González-Martín-Moro
- Servicio de Oftalmología, Hospital del Henares, Coslada, Madrid, España; Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España
| | - J Zarallo-Gallardo
- Servicio de Oftalmología, Hospital del Henares, Coslada, Madrid, España; Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España
| | - I Lozano Escobar
- Servicio de Oftalmología, Hospital del Henares, Coslada, Madrid, España
| | - R Cobo-Soriano
- Servicio de Oftalmología, Hospital del Henares, Coslada, Madrid, España; Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España
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