THE EVOLUTION Of FULL-THICKNESS MACULAR HOLE AFTER SHORT EXPOSURE TO HIGH-POWERED HANDHELD LASER POINTER.

Purpose: To report a case of a full-thickness macular hole after exposure to an extremely powerful handheld laser pointer.

Methods: A 14-year-old boy with a laser-induced full-thickness macular hole was evaluated 1 month after a momentary exposure to a 5,000 mW blue laser pointer. Imaging modalities including fundus color, autofluorescence, and spectral-domain optical coherence tomography, acquired both at our clinic and by the referring physician soon after the injury, are used to describe the clinical evolution of the case.

Results: Soon after the injury, an intensely white, circular opacification of the retina approximately 400 μm in diameter was seen in the fovea. Early spectral-domain optical coherence tomography images showed full-thickness hyperreflectivity, likely representing tissue necrosis. One month later, a full-thickness macular hole and eradication of the retinal pigment epithelium at its base were evident in the fundus color, autofluorescence, and spectral-domain optical coherence tomography images.

Conclusion: High-power laser pointers have become easily available online. The presenting findings after exposure to such high-power devices are distinct from those reported after exposure to weaker laser pointers. Although long exposure to weaker lasers typically produces extensive, calligraphic figures and yellow placoid lesions involving only the outer retina, in our case, a very brief exposure led to focal full-thickness injury of the fovea.