Ocular damage secondary to lights and lasers: How to avoid and treat if necessary

Experience with 808-nm diode laser in the treatment of 47 cases of oral vascular anomalies

Treatment of oral vascular anomalies (OVA) has focused on minimally invasive techniques rather than radical surgery. We investigated the efficacy and safety of diode laser using the photocoagulation technique in the management of OVA. Forty-seven subjects with OVA were treated with forced dehydration with induced photocoagulation (FDIP) using diode laser (808 nm/4.5 W). This series consisted mostly of male (63.8%) and non-white (63.8%) patients with a mean age of 57.4 years. Varices (91.5%), venous malformations (6.4%), and hemangiomas (2.1%) with a mean size of 7.1 (±4.9) mm were the conditions treated. OVA presented as a nodular lesion (63.8%) involving mainly the lower lip (46.8%). Pulsed laser mode was used as standard and the number of applications varied from one to four sessions, with the majority requiring only one (83%) FDIP session. Kaplan-Meier analysis revealed that complete clinical healing can occur on the 15th day (n=9/29.5%), followed by the 20th (n=6/45.5%), and 30th (n=7/70.5%) days. Postoperative edema was observed in 31 (66%) patients, and recurrence of the lesion occurred in two (4.2%). Based on the data on complete clinical healing, minimal patient discomfort, and satisfactory esthetic results, we can confirm that FDIP by diode laser is a promising candidate for the safe and efficacious treatment of OVA.

Ocular Complications After Laser or Light-Based Therapy-Dangers Dermatologists Should Know

BACKGROUND

Laser and light-based technologies have been used in the medical field for over 50 years. In dermatologic and cosmetic practice, cutaneous side effects are commonly discussed; however, ocular injury may also occur.

OBJECTIVE

To complete a systematic review of the current literature regarding ocular complications in the dermatologic field after laser and/or light-based therapies.

MATERIALS AND METHODS

A systematic review of the Medline database was performed in August 2020 using the search terms "laser or light and ocular and complication." The inclusion criteria were articles written in English discussing ocular complications after laser or light-based therapy for dermatologic or cosmetic indications.

RESULTS

A total of 36 articles were included for review. Carbon dioxide was the most frequently used laser causing ocular damage, and the most common ophthalmologic complication was temporary ectropion. Patients described visual disturbances and pain as the most common symptoms. A large proportion of articles did not report the use of appropriate eye protection at the time of injury.

CONCLUSION

Although ocular injury post-laser or light-based procedures are rare, clinicians must be acutely aware of the signs and symptoms associated with eye damage. The informed consent process should thoroughly describe the possibility of ocular complications post-treatment, and medical practices should have appropriate emergency plans and protective equipment in place to decrease both patient and staff risk of injury.

Potential of laser-induced fluorescence-light detection and ranging for future stand-off virus surveillance

Viruses remain a significant public health concern worldwide. Recently, humanity has faced deadly viral infections, including Zika, Ebola and the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The threat is associated with the ability of the viruses to mutate frequently and adapt to different hosts. Thus, there is the need for robust detection and classification of emerging virus strains to ensure that humanity is prepared in terms of vaccine and drug developments. A point or stand-off biosensor that can detect and classify viruses from indoor and outdoor environments would be suited for viral surveillance. Light detection and ranging (LiDAR) is a facile and versatile tool that has been explored for stand-off detection in different environments including atmospheric, oceans and forest sensing. Notably, laser-induced fluorescence-light detection and ranging (LIF-LiDAR) has been used to identify MS2 bacteriophage on artificially contaminated surgical equipment or released amidst other primary biological aerosol particles in laboratory-like close chamber. It has also been shown to distinguish between different picornaviruses. Currently, the potentials of the LIF-LiDAR technology for real-time stand-off surveillance of pathogenic viruses in indoor and outdoor environments have not been assessed. Considering the increasing applications of LIF-LiDAR for potential microbial pathogens detection and classification, and the need for more robust tools for viral surveillance at safe distance, we critically evaluate the prospects and challenges of LIF-LiDAR technology for real-time stand-off detection and classification of potentially pathogenic viruses in various environments.

Survey of reported eye injuries from handheld laser devices in Canada

BACKGROUND

Unprotected exposure to handheld lasers can cause temporary or permanent vision loss depending on the laser classification.

OBJECTIVE

To evaluate the occurrence of, and details associated with, reported eye injuries resulting from handheld lasers.

METHODS

A 14-item questionnaire developed by Health Canada was distributed by the Canadian Ophthalmological Society and the Canadian Association of Optometrists to their respective members.

RESULTS

Questionnaire data were available from 909 respondents (263 ophthalmologists; 646 optometrists). Response rates were 23.1% and 12.7%, respectively. Validated data were available from 903 respondents, where 157 (17.4%) reported encountering at least 1 eye injury from a handheld laser. A total of 318 eye injuries were reported with an annual increase of 34.4% (95% CI 21.6%-48.7%, p < 0.0001) between 2013 and 2017. When respondents reported on only their most severe case, 77 (53.5%) reported vision loss that ranged from minor to severe, which persisted for more than 6 months in 42.9% of the cases. Another 59 (41.3%) noted the presence of retinal damage. The prevalence of eye injuries from handheld lasers was higher for males (82.5%) than females (14.0%), more frequent among those under the age of 50 years, and occurred predominately as a result of exposure from another person (67.6%) versus self-induced (26.1%) (p < 0.0001).

CONCLUSIONS

Although this pilot study permits insight into the potential prevalence of injuries resulting from exposure to handheld laser devices in Canada, the results are not nationally representative. These findings support additional surveillance activities that may inform risk assessment and potential risk management strategies.

Foveal choroidal neovascularization secondary to accidental laser exposure in a dermatologist: A case report

RATIONALE

Most laser-induced retinal injuries are caused by accidental laser discharge during the preparation of laser devices without protective goggles, laser injury during the cosmetic procedure in a dermatologist, is very rare, with no prior case reports.

PATIENT CONCERNS

A 55-year-old Asian male dermatologist visited our hospital with a 2-week history of visual disturbance in his right eye. He had experienced sudden central scotoma in the right eye while using a Q-switched Nd:YAG laser (1064 nm, 2 J/cm, 6-mm spot size, 750 ps) 2 to 3 cm from the target without proper eye protection. He had applied a glass slide firmly onto the treatment area prior to commencing the procedure. The choroidal neovascularization (CNV) was detected via optical coherence tomography angiography (OCTA) 2 weeks after the laser injury.

DIAGNOSIS

Foveal CNV secondary to laser energy reflected from the glass slide.

INTERVENTION

Intravitreal bevacizumab (1.25 mg/0.05 mL) injection was performed.

OUTCOMES

Regression of CNV was observed.

LESSONS

Retinal injury can occur not only by direct laser beam exposure but also by way of a beam reflected from a glass slide. Operators should always use laser safety eyewear during cosmetic procedures involving laser devices, so as to prevent the occurrence of ocular complications. Thorough short-term follow-up with OCTA is recommended for the prompt detection of CNV in cases of retinal laser injury.

Treatment of basal cell cancer in the periorbital area using a pulsed copper vapour laser

An increase in life expectancy in developed countries is inevitably accompanied by an increase in the number of nonmelanoma skin diseases, which are primarily represented by basal cell cancer (BCC) occurring in elderly and old-age patients. The pathogenesis of such diseases is associated both with impaired proliferation and differentiation of the keratinocytes of the epidermal basal layer, as well as with the transformation of the vasculature in the papillary dermis in the vicinity of BCC. In recent years, such conditions have been increasingly treated using CO2 , neodymium, diode and pulsed-dye lasers. In many cases, these devices allow malignant BCC cells to be successfully eliminated. However, the use of near-infrared lasers in the periorbital area is limited due to a higher risk of damaging the organs of the visual system. Therefore, a search for new laser surgery methods that can be used for treating malignant skin tumours seems to be a prospective research direction.Methods. 3 male and 9 female patients diagnosed with primary BCC were treated using a copper vapour laser (Yakhroma-Med). The age of the patients varied from 34 to 77 years. Laser treatment was carried out in one session under the following irradiation parameters: the wavelength of 511 and 578 nm, the average power of up to 3 W and a series of 15 ns pulses. The pause between the pulses was 60 μs, with the exposure time ranging from 200 to 600 ms. The light spot diameter on the skin surface was 1 mm. The follow-up monitoring duration was 24 months.Results. In all the BCC patients, one session of copper vapour laser treatment allowed malignant cells in the disease area to be completely eliminated without relapses during 2 years after the therapy. The duration of skin healing in the irradiated area was 2 weeks in patients under the age of 40 years, compared to 3–4 weeks in elderly patients. After the treatment, short-term side effects, such as a slight edema, erythema and peeling, were observed.