Rabiolo Alessandro, Sacconi Riccardo, Giuffrè Chiara, Corbelli Eleonora, Carnevali Adriano, Querques Lea, Sarraf David, Freund K Bailey, Sadda SriniVas, Bandello Francesco, Querques Giuseppe
Department of Ophthalmology, IRCCS San Raffaele, University Vita-Salute San Raffaele, Milan, Italy.
Department of Neurological and Movement Sciences, Eye Clinic, University of Verona, Verona, Italy.
Retin Cases Brief Rep. 2018;12 Suppl 1:S46-S50. doi: 10.1097/ICB.0000000000000640.
To report a case of factitious self-inflicted handheld laser-induced maculopathy.
A 29-year-old man presented to our clinic complaining of a step-wise progressive loss of vision that abruptly began in his left eye but then became bilateral. He underwent comprehensive ocular examination, including visual acuity testing, biomicroscopic, dilated funduscopic examination, structural optical coherence tomography, en face structural optical coherence tomography, optical coherence tomography angiography, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography.
Visual acuity was 20/200 in both eyes. Although the multimodal imaging was highly consistent with handheld laser-induced maculopathy, the patient continued to deny this behavior.
Self-inflicted handheld laser-induced maculopathy may be a novel manifestation of factitious disorder. Clinical suspicion for this should remain high in the presence of the signature multimodal retinal findings despite denial by the patient. This category of patients could benefit from psychiatric referral, to prevent further ocular or extra-ocular self-injury.
报告一例人为自伤性手持激光所致黄斑病变的病例。
一名29岁男性到我们诊所就诊，主诉视力呈逐步进行性下降，最初突然发生于左眼，随后累及双眼。他接受了全面的眼部检查，包括视力测试、生物显微镜检查、散瞳眼底检查、结构光学相干断层扫描、正面结构光学相干断层扫描、光学相干断层扫描血管造影、眼底自发荧光、荧光素血管造影和吲哚菁绿血管造影。
双眼视力均为20/200。尽管多模态成像结果与手持激光所致黄斑病变高度相符，但患者仍否认有此行为。
人为自伤性手持激光所致黄斑病变可能是人为障碍的一种新表现形式。尽管患者否认，但在出现典型的多模态视网膜表现时，临床仍应高度怀疑此病。这类患者可从精神科转诊中获益，以防止进一步的眼部或眼外自我伤害。
