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Laser Maculopathy
SECTION 25: PHOTIC MACULOPATHY
Laser Maculopathy Jay S. Duker
25.1
Summary
Key OCT Features
High-powered lasers have become common in both the commercial and recreational setting. This provides an opportunity for both accidental and purposeful exposure of the macula, which has increased in frequency during the 21st century. The central macula generally receives the majority of the injury because of direct visualization of the laser beam. Clinically, the acute lesion appears yellow and mottled which fade quickly over weeks to months. The later stages of injury are nonspecific, with varying amounts of retinal pigment epithelium (RPE) pigmentary disturbances and retinal atrophy. The extent of retinal injury depends on the burden of exposure, with mild injuries affecting only the outer retina; more severe injuries can affect the full retinal thickness.
• In acute setting, there is localized outer > inner retinal involve• •
BIBLIOGRAPHY Wyrsch S, Baenninger PB, Schmid MK. Retinal injuries from a handheld laser pointer. N Engl J Med. 2010;363(11):1089–1091.
Near full-thickness hyperreflectivity
S 1 T
ment, with hyperreflectivity involving the inner segment/outer segment/ellipsoid zone (IS/OS/EZ) and RPE (Figs. 1 and 2). In the subacute or chronic setting, patchy RPE disruption and clumping are present (Fig. 3). IS/OS/EZ normalization varies depending on severity of initial injury and correlates with visual recovery.
N
LASER maculopathy at baseline I
FIG. 1. OCT of fairly severe acute laser maculopathy.
FIG. 2. Corresponding color photograph to Fig. 1.
FIG. 3. OCT 6 weeks after the original injury. Restoration of normal inner retinal reflectivity
Persistent RPE and IS/OS/EZ disruption
S 1 T
N I
LASER maculopathy 6 weeks after injury
145
Laser Maculopathy Jay S. Duker
25.1
Summary
Key OCT Features
High-powered lasers have become common in both the commercial and recreational setting. This provides an opportunity for both accidental and purposeful exposure of the macula, which has increased in frequency during the 21st century. The central macula generally receives the majority of the injury because of direct visualization of the laser beam. Clinically, the acute lesion appears yellow and mottled which fade quickly over weeks to months. The later stages of injury are nonspecific, with varying amounts of retinal pigment epithelium (RPE) pigmentary disturbances and retinal atrophy. The extent of retinal injury depends on the burden of exposure, with mild injuries affecting only the outer retina; more severe injuries can affect the full retinal thickness.
• In acute setting, there is localized outer > inner retinal involve• •
BIBLIOGRAPHY Wyrsch S, Baenninger PB, Schmid MK. Retinal injuries from a handheld laser pointer. N Engl J Med. 2010;363(11):1089–1091.
Near full-thickness hyperreflectivity
S 1 T
ment, with hyperreflectivity involving the inner segment/outer segment/ellipsoid zone (IS/OS/EZ) and RPE (Figs. 1 and 2). In the subacute or chronic setting, patchy RPE disruption and clumping are present (Fig. 3). IS/OS/EZ normalization varies depending on severity of initial injury and correlates with visual recovery.
N
LASER maculopathy at baseline I
FIG. 1. OCT of fairly severe acute laser maculopathy.
FIG. 2. Corresponding color photograph to Fig. 1.
FIG. 3. OCT 6 weeks after the original injury. Restoration of normal inner retinal reflectivity
Persistent RPE and IS/OS/EZ disruption
S 1 T
N I
LASER maculopathy 6 weeks after injury
145