Raoof N, Bradley P, Theodorou M, Moore AT, Michaelides M. Am. J. Ophthalmol. 2016; 171: 88-94.
Affiliation
Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK EC1V 2PD; University College London Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK. Electronic address: michel.michaelides@ucl.ac.uk.
PURPOSE: To characterize a large single-center series of retinal injuries in children secondary to hand-held laser devices, with emphasis on potential prognostic factors.
DESIGN: Retrospective case series.
METHODS: Sixteen children (24 eyes) with retinal injuries secondary to hand-held lasers were identified from our electronic patient record system. Case-notes, digital fundus photography and spectral-domain optical coherence tomography images were reviewed.
RESULTS: The mean age of affected children was 12.7 years (range 9-16 years), with 12 males and 4 females. Mean follow up was 5.4 months (range 1 to 23 months). Five (31%) children were referred as suspected retinal dystrophies. The mean logMAR visual acuity at presentation was 0.30 (20/40) (range -0.20 (20/12.5) to 1.6 (20/800)). Eleven (69%) children (15 eyes) had 'mild' injuries with focal retinal disruption confined to the photoreceptor and ellipsoid layers; such injuries were associated with a better prognosis, the mean visual acuity at presentation being 0.10 (20/25). 'Moderate' injuries were seen in 3 eyes of 2 children, with retinal disruption confined to the outer retinal layer but diffuse rather than focal in nature. Three patients (4 eyes) had 'severe' injuries, with subfoveal outer retinal architecture loss and overlying hyper-reflective material in inner retinal layers.
CONCLUSION: Retinal injuries secondary to hand-held laser devices may be difficult to diagnose and are likely under-reported. It is important that such data are in the public domain, so regulatory authorities recognize the importance of laser retinopathy as an avoidable cause of childhood visual impairment and take steps to minimize the incidence and impact of laser injuries.