This case report presents treatment outcomes for a patient with accidental laser-induced retinal injury. A 30-year-old man was evaluated for a sudden decrease of vision and metamorphopsia in his left eye after staring at a laser in a nightclub five days before presentation. Eye examination showed left visual acuity of 6/18-2 unaided, which improved to 6/12-2 on the pinhole test. Dilated fundoscopy showed a yellow-orange foveolar lesion in the left eye. Optic coherence tomography (OCT) showed an alteration of foveal anatomy predominantly involving the outer retinal layers, hyper-reflective vertical bands, and large cystoid change at the inner retina. Foveolar thickness was increased to 397 µ. Treatment was initiated with oral corticosteroids (prednisolone 0.5 mg/kg/day). At the one-week follow-up, left visual acuity improved to 6/12+2. Hardly any cystic changes were noted, with fewer hyper-reflective bands and less disruption at the outer layer. Treatment with prednisolone was continued and lutein capsules (20 mg/day) were added. At three weeks, the patient reported a return to normal vision, with left visual acuity of 6/6-2 unaided. On OCT, nearcomplete restoration of the macular structure was visualized. Although these results show positive clinical outcomes with combined oral corticosteroids and lutein over a short time for a typical case of laser-induced maculopathy, further review is recommended to determine the ideal treatment regimen.

Introduction:A 30yopatient presented sudden decrease of left vision and metamorphopsia after staring at a laser in a nightclub five days before. Results:At presentation left visual acuitywas 6/18-2 unaided improving to 6/12-2 pinhole.Dilated fundoscopy showed a yellow-orange foveolar lesion in the left eye. OCT showed an alteration of foveal anatomy involving predominantly the outer retinal layers, hyper-reflective vertical band and large cystoid change at the inner retina. There was an increase of foveolar thickness to 397µ.Treatment was with oral corticosteroids (Prednisolone 0.5mg/ Kg).At one week left visual acuityimprovedto 6/12+2.There were hardly any cystic changes, with less hyper-reflective band and disruption at the outer layer.Lutein capsules 20 mg daily were added at one week. At three weeks patient reported vision back to normal - the left visual acuity was 6/6-2 unaided. OCT showed near-complete restoration of macular structure. Conclusions: Positive clinical outcome with combined oral corticosteroids and lutein over a short period of time in a typical case – further review recommended of ideal treatment regimes for laser induced maculopathy.

Purpose: Emphasizing the importance of regular vision screening with visual fields and rapid MRI investigations where a field defect is unexplained. A 44 yo patient with a history of headache and incipient development of hemianopia gradually noticed bumping into things on the left‐hand side. In the last 6 months she also described 2 clear episodes of 5 min absence seizures, when she was staring into space. She has a history of iron deficiency being treated. Visual acuity was 6/6 corrected, right eye and 6/6‐2, corrected left eye. Normal pupillary reflexes. Visual fields showed gross left homonymous hemianopia. Optic discs showed no palor or cupping. Methods: Brain MRI showed a complex right temporal arteriovenous malformation (AVM) predominately supplied from the middle cerebral artery. There is a variceal dilation. There was some gliosis in the right temporal lobe suggesting previous bleed. Results: Urgent neurosurgeon assessment and catheter angiogram found a complex AVM which will likely be treated with gamma knife or embolization given patient age and previous evidence of bleed. Conclusions: This interesting case illustrates the importance of urgent imaging when faced with an abnormal visual field defect with no other underlying pathology. References 1. M. J. Kupersmith, M. E. Vargas, A. Yashar, M. Madrid, K. Nelson, A. Seton, A. Berenstein Occipital arteriovenous malformations Visual disturbances and presentation. 1996. DOI: https://doi.org/10.1212/WNL.46.4.953 2. Homonymous hemianopia: challenges and solutions. Clin Ophthalmol. 2014; 8: 1919–1927. Published online 2014 Sep 22. doi: 10.2147/OPTH.S59452 3. Nisha S. Dhawlikar and Yosbelkys Martin Paez. Man presents with visual field changes over 1 year https://www.healio.com/news/ophthalmology/20210827/man-presents-with-visual-field-changes-over-1-year