Retinal injury after inadvertent handheld laser exposure.
OBJECTIVE
To evaluate acute and long-term clinical and spectral domain optical coherence tomography features after handheld laser exposure to the retina.


METHODS
Retrospective case series of three children with retinal injury secondary to inadvertent handheld laser exposure. All individuals underwent ophthalmologic examination and spectral domain optical coherence tomography at presentation and follow-up 11 months to 18 months after exposure.


RESULTS
Three male children aged 6 years to 10 years sustained bilateral macular injury after exposure to a handheld green or red laser. Two of the three handheld lasers were ordered from foreign internet retailers and were labeled as Class 3B devices. Acutely, flat yellow deep retinal lesions with pigment irregularity were apparent. Spectral domain optical coherence tomography demonstrated disruption of the external limiting membrane and outer photoreceptors, a hyperreflective mound extending from the external limiting membrane to the retinal pigment epithelium, and linear opacification in Henle's layer. Over time, there was partial restoration of the external limiting membrane and persistent irregularity of the outer photoreceptor layers. Two individuals with severe vision loss acutely had some improvement of Snellen acuity at a 1-year follow-up.


CONCLUSIONS
Handheld lasers can produce permanent retinal damage with visual sequelae if improperly used. Spectral domain optical coherence tomography demonstrates chronic disruption, primarily in the retinal pigment epithelium/photoreceptor region.
*Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, Massachusetts; and †Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania.
Gregory D
GD
Lee
Caroline R
CR
Baumal
David
D
Lally
John D
JD
Pitcher
James
J
Vander
Jay S
JS
Duker
D000284:Administration, Oral; D002648:Child; D005131:Eye Injuries / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007834:Lasers / Q000009:adverse effects*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D020419:Photoreceptor Cells, Vertebrate / Q000473:pathology; D010988:Play and Playthings; D011998:Recreation; D012160:Retina / Q000187:drug effects / Q000293:injuries* / Q000473:pathology; D055213:Retinal Pigment Epithelium / Q000473:pathology; D012189:Retrospective Studies; D012607:Scotoma / Q000175:diagnosis / Q000188:drug therapy; D041623:Tomography, Optical Coherence; D014792:Visual Acuity
D005938:Glucocorticoids; D008775:Methylprednisolone