Foveal choroidal neovascularization secondary to accidental laser exposure in a dermatologist

Abstract

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 2 , 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.

Survey of the use of laser protective eyewear among international retina specialists: a European vitreoretinal society study

“…First, most laser-induced retinal injuries are caused by accidental laser discharge during the preparation of laser devices with the medical personnel directly looking at the source of laser without protection. 7 8 Second, damage to the laser equipment might result in unintentional emergence of radiation, for example from a damaged endolaser probe or faulty laser filters as reported in this survey. Finally, psychosocial issues of the surgeons may be a potential cause for laser injury.…”

Cosmetic Laser Related Retinal Injuries

“…The wavelength of Nd:YAG 1064 nm laser makes it invisible to human eye and allows it to penetrate deeper into tissue compared to shorter wavelength of laser, making intraocular structures vulnerable to injury. In the cases reported by Chen, et al, Kim, et al, and Lee, et al, fibrosis occurred after retinal hemorrhage was absorbed, which resulted in scar formation and adhesions rather than progression into retinal detachment [9,11,12].…”

“…Cosmetic laser related eye injury was rare, and as an occupational hazard to the laser operating personnel was even rarer. Four case reports were found for cosmetic laserinduced retinal injury [9][10][11][12]. Their clinical histories and outcomes were summarized in Table 1.…”

Laser-induced choroidal neovascularization

“…The incidence of laser induced eye injures has been on a rise because the wide use of laser in many spheres of human activity such as industry, [ 9 ] military, [ 10 ] medicine, [ 11 ] and entertainment. [ 12 ] The safety level of laser products is categorized according to the American National Standard Institute and Food and Drug Administration.…”