Nghiem-Buffet Sylvia, Gaudric Alain, Cohen Salomon Y
Ophthalmology Center for Imaging and Laser, 11 Rue Antoine Bourdelle, 75015, Paris, France.
Department of Ophthalmology, University of Paris 13, Avicenne Hospital, 125 Route de Stalingrad, 93000, Bobigny, France.
Am J Ophthalmol Case Rep. 2019 Dec 19;17:100578. doi: 10.1016/j.ajoc.2019.100578. eCollection 2020 Mar.
To report multimodal imaging of lesions due to the unprotected observation of the sun with an astronomical telescope, mimicking self-inflicted handheld laser-induced macular lesions.
A 44-year old man was diagnosed with chronic central serous chorioretinopathy leaving a relative scotoma in his left eye, with visual acuity limited to 20/40. He complained of a sudden visual loss to 20/400. Fundus examination showed a yellowish discoloration of the fovea. Fundus autofluorescence pictures showed hyper-autofluorescent spots that were hyperfluorescent both on fluorescein and indocyanine-green angiography. Spectral-domain optical coherence tomography (SD-OCT) showed hyper-reflective foveal outer layers, and OCT-angiography showed dark areas at the choriocapillaris. Multimodal imaging was highly suggestive of self-inflicted handheld laser-induced lesions that were ruled out by the patient. He remembered having observed the sun during an astronomical session, looking for solar winds. The main astronomical telescope was protected by a specific filter, but the aiming side-telescope was incidentally not protected by any filter.
The unprotected observation of the sun with an astronomical telescope may result in visual loss due to macular burns that may mimic self-inflicted handheld laser-induced lesions. This hypothesis should be searched before concluding denied self-injuries.
报告因使用天文望远镜无防护观测太阳导致的病变的多模态成像，其表现类似手持激光自伤所致的黄斑病变。
一名44岁男性被诊断为慢性中心性浆液性脉络膜视网膜病变，左眼遗留相对暗点，视力降至20/40。他主诉视力突然降至20/400。眼底检查显示黄斑区发黄。眼底自发荧光图像显示高自发荧光斑点，在荧光素和吲哚菁绿血管造影中均为高荧光。频域光学相干断层扫描（SD-OCT）显示黄斑外层高反射，光学相干断层扫描血管造影显示脉络膜毛细血管层有暗区。多模态成像高度提示为手持激光自伤所致病变，但患者否认。他记得在一次天文观测期间观测太阳以寻找太阳风。主天文望远镜有特定滤光片保护，但瞄准用的侧望远镜偶然未受任何滤光片保护。
用天文望远镜无防护观测太阳可能因黄斑灼伤导致视力丧失，这种灼伤可能类似手持激光自伤所致病变。在判定为非自伤之前应探究这一假说。
