Laser-Induced Maculopathy and Outcomes After Treatment With Corticosteroids and Lutein

Abstract

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.

Case Report: Multimodal, Longitudinal Assessment of Retinal Structure and Function following Laser Retinal Injury

“…In milder cases where surgeries are not indicated, evidence-based medical intervention is limited. Several studies showed visual and structural improvement with a short course of oral corticosteroid treatment immediately after the laser exposure 1,12–15 . The corticosteroid was suggested to reduce inflammatory response by decreasing the retinal pigment epithelium migration and proliferation in response to the laser-related injury 12,13 .…”

“…5 In general, most of the reported laser retinal injury cases showed reversible retinal damage with corticosteroid or surgical treatment, although having a permanent scotoma was also not uncommon. 5,[11][12][13][14][15] Previous literature showed the management of laser retinal damage cases including observation, 9 oral corticosteroid, 1,[12][13][14][15] and surgical intervention, 11 depending on the injury severity.…”

“…Several studies showed visual and structural improvement with a short course of oral corticosteroid treatment immediately after the laser exposure. 1,[12][13][14][15] The corticosteroid was suggested to reduce inflammatory response by decreasing the retinal pigment epithelium migration and proliferation in response to the laser-related injury. 12,13 Further study comparing steroid use and observation would only shed light on whether steroid treatment would be indicated.…”

“…Even relatively low-power laser pointers can cause retinal injury if misused. The extent of ocular damage depends on the duration of exposure and the properties of the laser, such as beam diameter, beam vergence, wavelength, and power output 1–3 …”

“…The extent of ocular damage depends on the duration of exposure and the properties of the laser, such as beam diameter, beam vergence, wavelength, and power output. [1][2][3] Laser light damage can occur by three mechanisms: photothermal, photomechanical, or photochemical. 2,3 Photothermal damage occurs when the energy from the laser is transferred to the pigment of the cells as heat, causing protein denaturation and cell death.…”