Stein Gregory E, Jung Jesse J, Bodine Steven, Trokel Stephen L, Chang Stanley
Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, NY, USA.
East Bay Retina Consultants, Inc., Oakland, CA, USA.
Taiwan J Ophthalmol. 2016 Oct-Dec;6(4):195-198. doi: 10.1016/j.tjo.2016.05.005. Epub 2016 Jun 20.
The Q-switched Nd:YAG laser can cause significant ocular injury, because it can emit an invisible and powerful load of energy in a short period of time. One of these injuries is macular hole formation. We report the case of a 21-year-old woman who presented with acute floaters in her left eye after exposure to a Q-switched Nd:YAG laser. Her initial best-corrected visual acuity (BCVA) in the left eye was 20/80. Examination demonstrated an acute vitreous hemorrhage, and spectral-domain optical coherence tomography (SD-OCT) confirmed a full-thickness macular hole (FTMH). Four months after her injury, her BCVA deteriorated to 20/400, and she underwent vitrectomy, internal limiting membrane peeling, and gas injection. Three weeks following the procedure, her FTMH was closed, however, her BCVA remained 20/150. At her last office visit, 19 months after the surgery, the examination was unchanged. There are few reports of vitrectomy to close an FTMH after Nd:YAG laser exposure, and the factors that contribute to visual recovery remain unclear. The aim of this case report is to emphasize the importance of early diagnosis and surgical repair, and to review the literature and surgical outcomes of cases of Nd:YAG laser-induced macular holes. Imaging with SD-OCT was essential in evaluating the visual outcome, as it was dependent on the degree of photoreceptor and retinal pigment epithelium injury.
调Q开关Nd:YAG激光可导致严重的眼部损伤，因为它能在短时间内发射出不可见且能量强大的光束。其中一种损伤就是黄斑裂孔的形成。我们报告一例21岁女性病例，她在接触调Q开关Nd:YAG激光后左眼出现急性飞蚊症。其左眼最初的最佳矫正视力（BCVA）为20/80。检查发现急性玻璃体出血，光谱域光学相干断层扫描（SD - OCT）证实为全层黄斑裂孔（FTMH）。受伤四个月后，她的BCVA恶化至20/400，随后接受了玻璃体切除术、内界膜剥除术及气体注入术。术后三周，她的FTMH闭合，但BCVA仍为20/150。在术后19个月的最后一次门诊随访时，检查结果无变化。关于Nd:YAG激光暴露后行玻璃体切除术闭合FTMH的报道较少，且影响视力恢复的因素仍不清楚。本病例报告的目的是强调早期诊断和手术修复的重要性，并回顾Nd:YAG激光诱导黄斑裂孔病例的文献及手术结果。SD - OCT成像对于评估视力结果至关重要，因为它取决于光感受器和视网膜色素上皮的损伤程度。
