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Laser pointer–induced macular injury
effects of treatment with adenine arabinoside. Ann Intern Med 1980;93:655– 664. 3. Nishi M, Hanashiro R, Mori S, et al. Polymerase chain reaction for the detection of the varicella-zoster genome in ocular samples from patients with acute retinal necrosis. Am J Ophthalmol 1992;114:603– 609. 4. Egbert PR, Pollard RB, Gallagher JG, et al. Cytomegalovirus retinitis in immunosuppressed hosts, II: ocular manifestations. Ann Intern Med 1980;93:664 – 670. 5. Schwoerer J, Othenin-Girard P, Herbort CP. Acute retinal necrosis: a new pathophysiological hypothesis. Ophthalmologica 1991;203:172–175.
Laser Pointer–Induced Macular Injury Jeffrey K. Luttrull, MD, and John Hallisey, MD PURPOSE:
FIGURE 2. (a) Light microscopic appearance of the retinal biopsy showing enlarged ganglion cells (arrow), with granular appearance of their cytoplasm consistent with intracytoplasmic inclusion bodies. (b) Immunohistochemical staining of the retinal biopsy showing several ganglion cells stained with the antibody to cytomegalovirus (arrow).
To report a patient with a macular injury caused by a laser pointing device. METHODS: Case report. A healthy 34-year-old man was examined 2 days after he deliberately gazed into the beam of a laser-pointing device with his left eye for an estimated 30 to 60 seconds. His uncorrected visual acuity in each eye was 20/20. He reported a transient central scotoma in the left eye and headache after laser exposure. RESULTS: Both eyes were unremarkable except for a focal retinal pigment epithelial disturbance at the nasal edge of the fovea in the left eye. Fundus fluorescein angiography demonstrated window- defect type hyperfluoresence in the same location. CONCLUSIONS: Laser-pointing devices may cause macular injury when used inappropriately. Conformance with consumer safety recommendations should minimize potential hazards. (Am J Ophthalmol 1999;127:95–96. © 1999 by Elsevier Science Inc. All rights reserved.)
A
34-YEAR-OLD HISPANIC MAN REQUESTED EXAMINA-
REFERENCES
tion, concerned that he may have injured his left eye with a laser-pointing device. Two days previously, he had deliberately gazed directly into the beam of a laser-pointing device, which he held 8 to 10 inches away from his left eye, for an estimated 30 to 60 seconds. Immediately after exposure, he noted a red central scotoma in his left eye and headache, both of which resolved by the following day. His medical and ocular histories were unremarkable. Ocular examination disclosed uncorrected visual acuity of BE, 20/20. Ocular motility, confrontation visual fields, pupillary responses, Amsler grid testing, and biomicroscopy of both eyes were unremarkable. Funduscopy of the right eye was unremarkable, and in the left eye, a focal disturbance of the retinal pigment epithe-
1. Duker JS, Blumenkranz MS. Diagnosis and management of the acute retinal necrosis syndrome (ARN). Surv Ophthalmol 1995;35:327–343. 2. Pollard RB, Egbert PR, Gallagher JG, et al. Cytomegalovirus retinitis in immunosuppressed hosts, I: natural history and
Accepted for publication June 9, 1998. Dr Luttrull is in private practice in Ventura, California. Dr Hallisey is in private practice in Camarillo, California. Inquiries to Jeffrey K. Luttrull, MD, 3160 Telegraph Rd, Ste 230, Ventura, CA 93003; fax: (805) 650-0865.
Our patient was immunocompromised and had active zoster dermatitis. She presented with notable anterior chamber reaction, keratic precipitates, and vitritis. The retinitis foci progressed rapidly to tears and detachments bilaterally, suggesting acute retinal necrosis. Polymerase chain reaction study of vitreous specimen and immunoperoxidase staining of retina were negative for varicella-zoster virus and herpes simplex but positive for cytomegalovirus. In conclusion, cytomegalovirus may rarely cause acute retinal necrosis and should be considered among the viral etiologies of this syndrome. Polymerase chain reaction studies of the vitreous biopsy may help in diagnosis.
VOL. 127, NO. 1
BRIEF REPORTS
95
exposed had a maximum power rating of 5 mW (US Food and Drug Administration class IIIa laser) with a 670-nm wavelength (Apollo Audio Visual Model MP-1600, Ronkonkoma, New York). Operational instructions packaged with the device included a warning stating, “Do not stare into the laser beam. Do not direct the beam toward a person’s eyes.” Affixed to the side of the device itself was an additional warning label stating, “Laser light—Avoid direct eye exposure.” Most cases of laser-induced retinal injury result from accidental exposure to high-energy class IV lasers with military, laboratory, or medical applications.1 Used appropriately, low-energy class IIIa laser devices pose little risk of retinal injury.2 Consequently, reports of such low-energy laser devices causing retinal injury are rare.3 Two factors may have contributed to the development of the macular lesion noted in this patient. First, racial fundus pigmentation may have increased absorption of the laser energy at the level of the retinal pigment epithelium and choroid, accentuating the effect of the low-power laser.4 Second, the effect of prolonged intentional self-exposure of the patient’s eye to the laser beam may have played a more important role. The findings in this case emphasize the importance of cautious and appropriate use of low-energy class IIIa laser devices. Misuse and failure to heed safety recommendations may result in retinal injury.
FIGURE 1. Red-free fundus photograph of the patient’s left eye 2 days after prolonged gazing into beam of class IIIa laser-pointing device. Note focal lesion at level of retinal pigment epithelium in nasal macula (arrow).
REFERENCES
1. Wolfe JA. Laser retinal injury. Mil Med 1985;150:177–185. 2. United States Code of Federal Regulations. Title 21, chapter 1, part 1040, section 1040.10;1995:522–535. 3. Chen TL, Yang KR, Chen SM. Photic maculopathy by low energy laser beam: a case report. Chang Keng I Hsueh 1994;14:273–277. 4. Smiddy WE, Fine SL, Green WR, Glaser BM. Clinicopathologic correlation of krypton red, argon blue-green, and argon green laser photocoagulation in the human fundus. Retina 1984;4:15–21.
Idiopathic Giant Retinal Tears in Identical Twins Nauman A. Chaudhry, MD, Harry W. Flynn, Jr, MD, and Homayoun Tabandeh, MD
FIGURE 2. Intravenous fundus fluorescein angiogram of the patient’s left eye demonstrates window-defect type hyperfluoresence in nasal macula (arrow) after exposure to beam of laser pointer 2 days earlier.
PURPOSE:
To report idiopathic unilateral giant retinal tears with retinal detachment in identical twins that occurred 2 weeks apart.
lium was noted at the nasal edge of the fovea (Figure 1). Intravenous fluorescein angiography of the right eye was unremarkable and in the left eye, demonstrated mottled window-defect type hyperfluoresence in the nasal macula (Figure 2). The laser-pointing device to which this patient was 96
AMERICAN JOURNAL
Accepted for publication July 9, 1998. From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida. Inquires to Harry W. Flynn, Jr, MD, Bascom Palmer Eye Institute, 900 NW 17th St, University of Miami School of Medicine, Miami, FL 33136; fax: (305) 326-6417. OF
OPHTHALMOLOGY
JANUARY 1999
Laser Pointer–Induced Macular Injury Jeffrey K. Luttrull, MD, and John Hallisey, MD PURPOSE:
FIGURE 2. (a) Light microscopic appearance of the retinal biopsy showing enlarged ganglion cells (arrow), with granular appearance of their cytoplasm consistent with intracytoplasmic inclusion bodies. (b) Immunohistochemical staining of the retinal biopsy showing several ganglion cells stained with the antibody to cytomegalovirus (arrow).
To report a patient with a macular injury caused by a laser pointing device. METHODS: Case report. A healthy 34-year-old man was examined 2 days after he deliberately gazed into the beam of a laser-pointing device with his left eye for an estimated 30 to 60 seconds. His uncorrected visual acuity in each eye was 20/20. He reported a transient central scotoma in the left eye and headache after laser exposure. RESULTS: Both eyes were unremarkable except for a focal retinal pigment epithelial disturbance at the nasal edge of the fovea in the left eye. Fundus fluorescein angiography demonstrated window- defect type hyperfluoresence in the same location. CONCLUSIONS: Laser-pointing devices may cause macular injury when used inappropriately. Conformance with consumer safety recommendations should minimize potential hazards. (Am J Ophthalmol 1999;127:95–96. © 1999 by Elsevier Science Inc. All rights reserved.)
A
34-YEAR-OLD HISPANIC MAN REQUESTED EXAMINA-
REFERENCES
tion, concerned that he may have injured his left eye with a laser-pointing device. Two days previously, he had deliberately gazed directly into the beam of a laser-pointing device, which he held 8 to 10 inches away from his left eye, for an estimated 30 to 60 seconds. Immediately after exposure, he noted a red central scotoma in his left eye and headache, both of which resolved by the following day. His medical and ocular histories were unremarkable. Ocular examination disclosed uncorrected visual acuity of BE, 20/20. Ocular motility, confrontation visual fields, pupillary responses, Amsler grid testing, and biomicroscopy of both eyes were unremarkable. Funduscopy of the right eye was unremarkable, and in the left eye, a focal disturbance of the retinal pigment epithe-
1. Duker JS, Blumenkranz MS. Diagnosis and management of the acute retinal necrosis syndrome (ARN). Surv Ophthalmol 1995;35:327–343. 2. Pollard RB, Egbert PR, Gallagher JG, et al. Cytomegalovirus retinitis in immunosuppressed hosts, I: natural history and
Accepted for publication June 9, 1998. Dr Luttrull is in private practice in Ventura, California. Dr Hallisey is in private practice in Camarillo, California. Inquiries to Jeffrey K. Luttrull, MD, 3160 Telegraph Rd, Ste 230, Ventura, CA 93003; fax: (805) 650-0865.
Our patient was immunocompromised and had active zoster dermatitis. She presented with notable anterior chamber reaction, keratic precipitates, and vitritis. The retinitis foci progressed rapidly to tears and detachments bilaterally, suggesting acute retinal necrosis. Polymerase chain reaction study of vitreous specimen and immunoperoxidase staining of retina were negative for varicella-zoster virus and herpes simplex but positive for cytomegalovirus. In conclusion, cytomegalovirus may rarely cause acute retinal necrosis and should be considered among the viral etiologies of this syndrome. Polymerase chain reaction studies of the vitreous biopsy may help in diagnosis.
VOL. 127, NO. 1
BRIEF REPORTS
95
exposed had a maximum power rating of 5 mW (US Food and Drug Administration class IIIa laser) with a 670-nm wavelength (Apollo Audio Visual Model MP-1600, Ronkonkoma, New York). Operational instructions packaged with the device included a warning stating, “Do not stare into the laser beam. Do not direct the beam toward a person’s eyes.” Affixed to the side of the device itself was an additional warning label stating, “Laser light—Avoid direct eye exposure.” Most cases of laser-induced retinal injury result from accidental exposure to high-energy class IV lasers with military, laboratory, or medical applications.1 Used appropriately, low-energy class IIIa laser devices pose little risk of retinal injury.2 Consequently, reports of such low-energy laser devices causing retinal injury are rare.3 Two factors may have contributed to the development of the macular lesion noted in this patient. First, racial fundus pigmentation may have increased absorption of the laser energy at the level of the retinal pigment epithelium and choroid, accentuating the effect of the low-power laser.4 Second, the effect of prolonged intentional self-exposure of the patient’s eye to the laser beam may have played a more important role. The findings in this case emphasize the importance of cautious and appropriate use of low-energy class IIIa laser devices. Misuse and failure to heed safety recommendations may result in retinal injury.
FIGURE 1. Red-free fundus photograph of the patient’s left eye 2 days after prolonged gazing into beam of class IIIa laser-pointing device. Note focal lesion at level of retinal pigment epithelium in nasal macula (arrow).
REFERENCES
1. Wolfe JA. Laser retinal injury. Mil Med 1985;150:177–185. 2. United States Code of Federal Regulations. Title 21, chapter 1, part 1040, section 1040.10;1995:522–535. 3. Chen TL, Yang KR, Chen SM. Photic maculopathy by low energy laser beam: a case report. Chang Keng I Hsueh 1994;14:273–277. 4. Smiddy WE, Fine SL, Green WR, Glaser BM. Clinicopathologic correlation of krypton red, argon blue-green, and argon green laser photocoagulation in the human fundus. Retina 1984;4:15–21.
Idiopathic Giant Retinal Tears in Identical Twins Nauman A. Chaudhry, MD, Harry W. Flynn, Jr, MD, and Homayoun Tabandeh, MD
FIGURE 2. Intravenous fundus fluorescein angiogram of the patient’s left eye demonstrates window-defect type hyperfluoresence in nasal macula (arrow) after exposure to beam of laser pointer 2 days earlier.
PURPOSE:
To report idiopathic unilateral giant retinal tears with retinal detachment in identical twins that occurred 2 weeks apart.
lium was noted at the nasal edge of the fovea (Figure 1). Intravenous fluorescein angiography of the right eye was unremarkable and in the left eye, demonstrated mottled window-defect type hyperfluoresence in the nasal macula (Figure 2). The laser-pointing device to which this patient was 96
AMERICAN JOURNAL
Accepted for publication July 9, 1998. From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida. Inquires to Harry W. Flynn, Jr, MD, Bascom Palmer Eye Institute, 900 NW 17th St, University of Miami School of Medicine, Miami, FL 33136; fax: (305) 326-6417. OF
OPHTHALMOLOGY
JANUARY 1999