Bilateral macular injury from a green laser pointer

Figures & data

Figure 1 (A and B) Fundus photographs showing yellowish, oval-shaped drusenoid-like lesion with attenuation of the foveal reflex in both eyes. (C and D) Red-free fundus photographs showing heterogeneous foveal lesions. (E and F) Fluorescein angiogram showing early foveal hyperfluorescence with late ill-defined leakage in right eye and left eye, respectively. (G and H) Autofluorescence photos showed heterogeneous hyperfluorescence in the macula of both eyes.

Note: A,C,E, and G are right eye; B,D,F, and H are left eye.

Figure 2 Optical coherence tomography. (A and B) Disruption of the outer retinal layers with nonspecific retinal thickening in both eyes at presentation. (C and D) Disruption of the inner segment/outer segment junction in both eyes, at 3 months after presentation.

Note: A and C are right eye; B and D are left eye.

Table 1 Reported cases in the literature of retinal damage caused specifically by green lasers

Reference	Age (years)	Eye	Wavelength of laser (color)	Initial fundus findings	Initial OCT findings	Initial FAF findings	Initial FA findings	F/U	Findings at last F/U
Fujinami et al^Citation8	11	OD	Green, unknown wavelength, unknown power	Macular yellow exudate-like lesion or fibrous tissue surrounded by subretinal hemorrhage OD	–	–	n/s	36M	TD-OCT at 24 months F/U, macular CNV OD
Wyrsch et al^Citation10	15	OU	Green, unknown wavelength, 150 mW (class 3B)	Multiple tiny scars OD Macular edema and central subretinal hemorrhage OS	–	–	–	4M	On examination, foveal hyperpigmented scar OU
Ziahosseini et al^Citation11	Teens	OU	Green, unknown wavelength, unknown power	Foveolar burns with hyperpigmented borders OU	Subfoveal disturbances in the RPE OU	–	Foveolar window defect (ie, late leakage) OU	–	–
Hossein et al^Citation12	25	OD	Green, wavelength 532 nm, 3.5–4.5 mW (class 3A)	Yellow-white spot at foveola OD	On SD-OCT, foveolar full-thickness hyper-reflective signal OU	–	n/s	6M	On SD-OCT, residual disruption of retinal layer OD
Pollithy et al^Citation13	11	OU	Green, 532 ± 10 nm, < 100 mW (class B)	Circular-shaped defects of RPE with surrounding hyperpigmentation in fovea OU	On TD-OCT, foveolar disruption of retinal layer at RPE photoreceptor layer OU	Irregular areas of reduced autofluorescence in fovea OU	–	–	–
Dirani A (current study)	13	OU	Green, 532 nm, 5 mW (class 3A)	Foveolar yellowish, oval-shaped, drusenoid-like lesions OU	Disruption of outer retinal layers with nonspecific thickening OU	Foveolar areas of heterogenous hyperfluorescence OU	Foveolar late ill-defined leakage OU	3M	Disruption of IS/OS junction

Abbreviations: FAF, fundus autofluorescence imaging; FA, fluorescein angiography; F/U, follow-up; IS/OS, inner segment/outer segment; RPE, retinal pigment epithelium; TD-OCT, time domain optical coherence tomography; SD-OCT, spectral domain optical coherence tomography; OU, both eyes; OD, right eye; OS, left eye; CNV, choroidal neovascularization; M, months; n/s, non specified.

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