Marinescu Anca I, Hall Caterina M
Ophthalmology, Moorfields Eye Hospital, London, GBR.
Ophthalmology, University College London, London, GBR.
Cureus. 2021 Oct 4;13(10):e18470. doi: 10.7759/cureus.18470. eCollection 2021 Oct.
This case report presents treatment outcomes for a patient with accidental laser-induced retinal injury. A 30-year-old man was evaluated for a sudden decrease of vision and metamorphopsia in his left eye after staring at a laser in a nightclub five days before presentation. Eye examination showed left visual acuity of 6/18-2 unaided, which improved to 6/12-2 on the pinhole test. Dilated fundoscopy showed a yellow-orange foveolar lesion in the left eye. Optic coherence tomography (OCT) showed an alteration of foveal anatomy predominantly involving the outer retinal layers, hyper-reflective vertical bands, and large cystoid change at the inner retina. Foveolar thickness was increased to 397 µ. Treatment was initiated with oral corticosteroids (prednisolone 0.5 mg/kg/day). At the one-week follow-up, left visual acuity improved to 6/12+2. Hardly any cystic changes were noted, with fewer hyper-reflective bands and less disruption at the outer layer. Treatment with prednisolone was continued and lutein capsules (20 mg/day) were added. At three weeks, the patient reported a return to normal vision, with left visual acuity of 6/6-2 unaided. On OCT, near-complete restoration of the macular structure was visualized. Although these results show positive clinical outcomes with combined oral corticosteroids and lutein over a short time for a typical case of laser-induced maculopathy, further review is recommended to determine the ideal treatment regimen.
本病例报告展示了一名意外激光所致视网膜损伤患者的治疗结果。一名30岁男性在就诊前五天于一家夜总会盯着激光看后,因左眼视力突然下降和视物变形前来评估。眼部检查显示左眼裸眼视力为6/18 - 2,针孔测试后提高到6/12 - 2。散瞳眼底检查显示左眼有一处黄橙色的黄斑小凹病变。光学相干断层扫描(OCT)显示黄斑区解剖结构改变,主要累及视网膜外层、高反射垂直带以及视网膜内层的大囊样改变。黄斑小凹厚度增加到397微米。开始口服皮质类固醇(泼尼松龙0.5毫克/千克/天)进行治疗。在一周的随访中,左眼视力提高到6/12 + 2。几乎未发现任何囊样改变,高反射带减少,外层破坏减轻。继续使用泼尼松龙治疗并添加叶黄素胶囊(20毫克/天)。三周时,患者报告视力恢复正常,左眼裸眼视力为6/6 - 2。在OCT上,可见黄斑结构几乎完全恢复。尽管这些结果表明,对于典型的激光所致黄斑病变病例,联合口服皮质类固醇和叶黄素在短时间内取得了积极的临床效果,但仍建议进一步评估以确定理想的治疗方案。