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March 1, 2005

Optical Coherence Tomography Before and After Repair of a Macular Hole Induced by an Unintentional Argon Laser Burn

Arch Ophthalmol. 2005;123(3):404-405. doi:10.1001/archopht.123.3.404

A 29-year-old man was examined 24 hours after experiencing acute loss of central vision in his right eye while adjusting a mirror inside an industrial argon laser without eye protection. The patient stated that the laser was probably set to 300 mW and that the duration of exposure was the length of a blink reflex (typically 0.15-0.25 seconds). Visual acuity in the right eye was 20/80+2 at presentation, and on Amsler grid examination at 35-cm distance, he had a central scotoma of 1-cm in diameter. Dilated fundus examination revealed a small yellow-white spot in the central macula consistent with a foveal laser burn (Figure, A). Unlike recent reports of acute pulsed-laser injuries,1-3 no blood was associated with this acute thermal laser lesion. Optical coherence tomography (OCT) (Stratus OCT3; Carl Zeiss Meditec Inc, Dublin, Calif) showed increased density in the foveal area and a small plumelike extension into the vitreous that may represent condensation of photoreceptor nuclei and the inner limiting membrane at the foveola (Figure, B). One month after the injury, the patient returned to the clinic with a persistent central scotoma and visual acuity in the right eye of 20/80+1. On examination, a full-thickness macular hole with a cuff of subretinal fluid was visualized (Figure, C). The OCT demonstrated a full-thickness macular hole with cystoid changes adjacent to the hole (Figure, D). Five months after the initial injury, the patient underwent pars plana vitrectomy, posterior hyaloid stripping without inner limiting membrane removal, and placement of a 16% perfluoropropane gas bubble. At his 6-month postoperative examination, the patient noted a smaller central scotoma, and visual acuity in the right eye had improved to 20/40. On dilated fundus examination, the hole was closed, but a small, hypopigmented lesion remained in the fovea (Figure, E). The OCT revealed a normal foveal contour with a small lucency directly under the foveal depression that corresponded to interruption of the retinal pigment epithelium layer along with a possible residual foveolar detachment (Figure, F).

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