Selim Cevher Hıtıt Unıversıty Medıcıne Faculty, room of Ophthalmology, 019030 Corum, Turkey.http://orcid.org/0000-0002-7968-4876About ns author
ABSTRACT

The thermal results of laser cutting machines could damage the macula. A few research studies in a literature have described macular injury induced by industrial laser burns. The aim of this study was to report the clinical, visual, e optical coherence tomography result in naquela gold refinery worker with laser-induced maculopathy. Der 21-year-old masculine gold refinery worker had actually vision lose in his ideal eye ~ using naquela laser cutting maker without wearing laser eye protection gear. At the first visit (24 h later), his best-corrected visual acuity era 7/10 in ns right eye e 10/10 in a left eye. The anterior segment examination era normal. In fundus examination, focal, round, e yellowish lesion ser estar detected within the fovea. A optical coherence tomography findings were foveal exterior retinal disruptions e irregularities extending em ~ the exterior plexiform class to ns retina colours epithelium. ~ 4 months, a best-corrected visual acuity had improved come 1.0, and the optical coherence tomography findings had resolved.

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Keywords:Maculopathy; Macular degeneration; Tomography; optical coherence; Laser


RESUMO

Os efeito térmicos a partir de máquinas de corte a laser podem danificar naquela mácula. Poucos estude na literário tem descrito a lesão macular pela queimadura a laser industrial. Neste estudo, objetivamos relatar os achados clínicos, visual e de tomografia de coerência óptica em um trabalhadores de refinaria de ouro alcançar maculopatia induzida pela laser. O trabalhadores da refinaria de amarelo de 21 estou vivendo teve perda de visão durante olho direito no momento depois de alavancada uma máquina de cortar a laser sem usar acessório protetor ocular porque o laser. Sua acuidade visual ao melhor corrigida adquirindo de 7/10 enquanto olho para a direita e 10/10 durante olho esquerdo na primeiro consulta (24h depois). O exame a partir de segmento anterior estava normal. Durante exame de fundo de olho, injúrias focais, redondas e amareladas passou a ser detectadas dentro de da fóvea. Os resultado da tomografia de coerência óptica revelaram rupturas na fóvea da retina externo e irregularidades estendendo-se da camada plexiforme externa vir epitélio pigmentar da retina. Depois de 4 meses, a acuidade visual ao melhor corrigida melhorar para 1,0 e os resultado da tomografia de coerência óptica foram revigorados.

Descritores:Maculopatia; Degeneração macular; Tomografia de coerência óptica; Laser


development

Retina colors epithelium (RPE) e choroid absorb a light at der certain capacity and protect ns retina from the phototoxic and thermal effects of light. However, retinal dage may happen if ns effects of light exceed ns capacity for protection. Some factors, such together duration that exposure, power of ns device, wavelength, e degree that retinal pigmentation, ~ ~ important for macular damage(11 Barkana Y, Belkin M. Laser eye injuries. Surv Ophthalmol. 2000; 44(6):459-78.)).

Laser-induced maculopathies have been report by several researchers in a literature. Plenty of of these instances were linked with usar of a laser tip device. Laser machines ~ ~ used in various occupations, such together in naquela gold refinery. Macular injury may occur when workers use such devices (e.g., naquela laser cut machine) there is no wearing any protective equipment.

In this study, we report der case of laser-induced maculopathy resulted in by a laser cut machine, e the spontaneous improvement of clinical, visual, intuitivo field, and optical coherence tomography (OCT) findings.

situation REPORT

A 21-year-old patience presented to our clinic with intuitivo loss e central scotoma in his appropriate eye, which arisen acutely after exposure to laser light from der laser cutting device (1,060 nm, 70 W) for der few se conds while working in der gold refinery. Although he closed his left eye while working without wearing laser eye security gear, the laser light unexpectedly reflected top top his ideal eye. His best-corrected visual acuity (BCVA) on ns Snellen chart ser estar 7/10 in his right eye and 10/10 in his left eye. The anteriormente segment examination era normal. Intraocular push (Goldman applanation) ser estar 15 mmHg in a right eye e 13 mmHg in the left eye. In fundus examination, focal, round, e yellowish lesion foi ~ detected in a fovea (Figure 1A). Foveal lado de fora retinal disruptions and irregularities extending são de the outside limiting membrane to a retina pigment epithelium to be detected making use of OCT (Spectralis SD-OCT; Heidelberg Engineering, Heidelberg, Germany) (Figure 2A). A size of ns ellipsoid ar damage and RPE dage was 215 µm and 534 µm, respectively. Der computerized 10-2 visualmente field threshold test (Humphrey automated Perimeter; Humphrey Instruments, mountain Leandro, CA, USA) proved small centrais scotoma in ns right eye and a normal field in ns left eye (Figure 3A). A hole-in-the-card test, used for the detection of ns dominant eye, era utilized come explain a reasons responsible porque o the incident of dage only in the right eye. Testing revealed that a right eye was ns dominant eye. Finally, laser-induced photic maculopathy era diagnosed in a right eye, and no treatment ser estar recommended. Follow-up ser estar decided. After 4 months, BCVA enhanced to 10/10 and the foveal yellowish lesion became smaller (Figure 1B). Ns OCT result recovered with naquela minimal defect on the ellipsoid zone and RPE (83 µm) (Figure 2B). Ns defect size improved from 215 µm to 83 µm. Ns visual field analysis was usual (Figure 3B).


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Figure 1 A) Focal, round, and yellowish lesion within ns fovea. B) the foveal yellowish lesion after ~ 4 months (smaller than the o primeiro dia visit).
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Figure 2 A) Foveal exterior retinal disruptions e irregularities extending são de the outside limiting membrane to ns retina colours epithelium in OCT. A size of ns ellipsoid ar damage and RPE dage was 215 μm and 534 μm, respectively. B) ~ 4 months, minimal defect foi ~ observed on ns ellipsoid zone and RPE (83 μm).
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Figure 3 A) Small quartel general scotoma in the computerized 10-2 intuitivo field threshold test. B) ~ 4 months, a small centrais scotoma in a computerized 10–2 visual field threshold test had actually disappeared.

discussion

Accidental laser-associated maculopathy wake up infrequently. Ns effects of laser on a retina include outer retinal disruption, foveal hemorrhage, macular edema, epiretinal membrane, macular hole, and choroidal neovascularization(22 Alsulaiman SM, Alrushood AA, Almasaud J, Alzaaidi S, Alzahrani Y, Arevalo JF, et al.; rei Khaled Eye Specialist hospital Collaborative Retina study Group. High-power handheld blue laser-induced maculopathy: ns results of the rei Khaled Eye Specialist hospital Collaborative Retina estude Group. Ophthalmology. 2014;121(2):566-72.e1.). The Food and Drug administration recognizes four major hazard classe (I come IV) that lasers, consisting of three subclasses (IIa, IIIa, e IIIb). Higher aulas indicate much more powerful lasers and greater potential porque o serious injury if supplied improperly.

In both solar and laser-induced retinopathies, a pri marily affected structures ser estar the foveal photoreceptor exterior segments and RPE(33 king A, gottlieb E, Brooks DG, Murphy MP, Dunaief JL. Mitochondria-derived reactive oxygen types mediate blue light-induced death of retinal colours epithelial cells. Photochem Photobiol. 2004;79(5):470-5.). Initially, der yellowish lesion is it was observed in the fovea, which shows up to exchange mail to changes in a hyperreflective photoreceptor bands on OCT(44 Hossein M, Bonyadi J, Soheilian R, Soheilian M, Peyman GA. SD-OCT attributes of laser tip maculopathy before e after systemic corticosteroid therapy. Ophthalmic Surg Lasers Imaging. 2011 Dec 16;42 Online:e135-8.). Subsequently, ns yellowish lesion may transform into a reddish cyst-like lesion com surrounding mottled pigmentation. Alternatively, the yellowish lesion may become smaller and hyperreflective photoreceptor bands transform right into hyporeflective bands(44 Hossein M, Bonyadi J, Soheilian R, Soheilian M, Peyman GA. SD-OCT attributes of laser tip maculopathy before and after systemic corticosteroid therapy. Ophthalmic Surg Lasers Imaging. 2011 Dec 16;42 Online:e135-8.). The hyperreflectivity might be associated com photoreceptor injury e disorganization. Moreover, hyporeflectivity may be related to photoreceptor apoptosis and atrophy. Semelhante to other laser-induced retinopathies, in ours case, a focal, round, and yellowish lesion was detected in a fovea. Foveal exterior retinal disruptions e irregularities extending from the external limiting membrane to ns RPE were detected utilizing OCT.

Currently, there is no consensus regarding a treatment of this pathology. Lim et al. Reported ns treatment of laser pointer maculopathy com tapering quantia of oral- prednisolone in naquela 13-year-old patient(55 Lim ME, Suelzer J, Moorthy RS, Vemuri G. Thermal macular injury from naquela 154 mW green laser pointer. J AAPOS. 2014;18(6):612-4.). In addition, Turaka et al. Treated a 13-year-old male patient com tapering bondade of boca prednisolone (40 mg) for 3 weeks(66 Turaka K, Bryan JS, Gordon AJ, Reddy R, Kwong HM Jr, offer CH. Laser pointer induced macular damage: situation report and mini review. Int Ophthalmol. 2012;32(3):293-7.). Similarly, Combillet et al. Used intravenous injections the high-dose corticosteroids ao 3 dia in der patient com laser-induced maculopathy e reported the retinal lesions decreased slightly(77 Combillet F, Saunier V, Rougier MB, Delyfer MN, Korobelnik JF. Multimodal imaging in naquela case that self-inflicted laser-induced maculopathy. Eur J Ophthalmol. 2016;26(6):e155-7.).

Anti-inflammatory and anti-proliferative results of the steroids on RPE cells might recover ns laser pointer-induced damage(88 Ayalasomayajula SP, Ashton P, Kompella UB. Fluocinolone inhibits VEGF expression acima de glucocorticoid receptor in human being retinal colours epithelial (ARPE-19) cells and TNF-alpha-induced angiogenesis in chick chorioallantoic membrane (CAM). J Ocul Pharmacol Ther. 2009;25(2):97-103.). However, it is well established that steroid therapy is associated com both systemic e ocular lado effects. Systemic lado effects include osteo porosis, steroid-induced myopathy, boost in blood glucose levels, breakthrough of cushingoid features, impairment of expansion in young children, e increased hazard of contagious disease. Ocular side effects ser estar cataract, glaucoma, e central serous chorioretinopathy.

Zhao et al. Used oral- lutein (20 mg) porque o 4 mainly in a patient with laser pointer-induced maculopathy. Lock observed advancement in visualmente acuity a partir de 10/50 to 12/20 in 3 months(99 Zhao N, Liu L. Long-term transforms in optic coherence tomography in der child com laser pointer maculopathy: a case report and mini review. Photodiagn Photodyn Ther. 2017;18:264-6.). At the fim of the primeiro year, the último visual acuity of ns patient was 16/20. That is well created that lutein exerts anti-inflammatory e antioxidant effects, and has to be used ao macular disease, particularly age-related macular degeneration. However, early to a lack that a ao controle case in that study, Zhao et al. Stated that it foi ~ difficult to attract concrete conclusions regarding ns effectiveness the treatment with lutein(99 Zhao N, Liu L. Long-term alters in optic coherence tomography in a child with laser guideline maculopathy: naquela case report and mini review. Photodiagn Photodyn Ther. 2017;18:264-6.).

On ns other hand, part authors desired to observe a patients. Tomasso et al. Observed der 13-year-old boy com laser maculopathy; uma month later, a BCVA had actually improved são de 20/25 come 20/20, and the structure OCT showed finish resolution of the pathologic findings(1010 Tomasso L, Benatti L, La Spina C, Lattanzio R, Baldin G, Carnevali A, et al. Optical coherence tomography angiography findings in laser maculopathy. Eur J Ophthalmol. 2017;27(1):e13-5.). Similarly, Weng et al. Showed that naquela patient com laser maculopathy prove both visual and anatomic recovery during the follow-up period(1111 Weng CY, Baumal CR, Albini TA, Berrocal AM. Self-induced laser maculopathy in an adolescent young utilizing der mirror. Ophthalmic Surg Lasers Imaging Retina. 2015;46(4):485-8.).

In literature, most situations of laser-induced maculopathy ser estar caused by laser reminder devices. In our case, laser-in duced maculopathy ser estar induced by a laser cutting machine. In ~ the primeiro visit, a ellipsoid region damage and RPE esboço was 215 µm e 534 µm, respectively. However, partial RPE esboço was detected using OCT. In addition, over there was enquanto choriocapillaris damage. After 4 months, a ellipsoid zone damage had improved to 83 µm, e the RPE dage had nearly complete resolved. A BCVA enhanced to 10/10. A choriocapillaris removes ns waste products and provides nutrient to ns RPE e neurosensory retina(1212 Booij JC, Baas DC, Beisekeeva J, Gorgels TG, Bergen AA. Ns dynamic natureza of Bruch’s membrane. Prog Retin Eye Res. 2010; 29(1):1-18.). RPE cells have proliferative e migratory capacity(1010 Tomasso L, Benatti L, La Spina C, Lattanzio R, Baldin G, Carnevali A, et al. Optical coherence tomography angiography result in laser maculopathy. Eur J Ophthalmol. 2017;27(1):e13-5.). One unaffected choriocapillaris may help in a healing that RPE, and RPE cells may promote the healing the ellipsoid zone cells. Moreover, the present pesquisar revealed the visual e anatomical development can take place without any treatments in patients com laser-induced maculopathy.

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In instances in i m sorry the damage is relatively small e the choriocapillaris is not affected, observation might be preferred. In this way, the possible side effects the steroid therapy have the right to be prevented. In addition, a results that this estude showed that ns dominant eye is much more susceptible to dage than ns non-dominant eye. Wearing laser eye protection equipment is very important ao workers quem use ns laser cut machine.