High-power handheld blue laser-induced maculopathy: the results of the King Khaled Eye Specialist Hospital Collaborative Retina Study Group

Ophthalmology. 2014 Feb;121(2):566-72.e1. doi: 10.1016/j.ophtha.2013.09.006. Epub 2013 Nov 1.


Purpose: To report various types of maculopathy caused by momentary exposure to a high-power handheld blue laser.

Design: Consecutive case series.

Participants: Fourteen eyes of 14 patients.

Methods: Patients with a history of eye exposure to a blue laser device (450 nm and a power range of 150-1200 mW) to a single institution were included. Evaluation included a full ophthalmic examination, fundus photography, macular spectral-domain optical coherence tomography, and fundus fluorescein angiography.

Main outcome measures: Analysis of the types of maculopathy and vitreoretinal pathologic features.

Results: All patients were young males. The most common setting for injury was accidental at play. The types of maculopathies encountered were: a full-thickness macular hole (FTMH) in 4 eyes, a premacular subhyaloid hemorrhage in 5 eyes, premacular sub-internal limiting membrane hemorrhage in 2 eyes, an outer retinal disruption at the fovea in 1 eye, an epimacular membrane in 1 eye, and a schisis-like cavity in 1 eye. Best-corrected Snellen visual acuity at presentation ranged from 20/40 to 4/200 (mean, 20/290). Only 4 eyes (29%) improved spontaneously with increase in vision, whereas 10 eyes (71%) required intervention. The latter consisted of neodymium:yttrium-aluminum-garnet hyaloidotomy in the 5 eyes with subhyaloid hemorrhage and pars plana vitrectomy (PPV) for the eyes with FTMH and epimacular membrane. All 4 FTMH were closed successfully after PPV. Final mean best-corrected visual acuity in all cases was 20/35 (range, 20/15-20/300).

Conclusions: Exposure to high-power handheld laser devices can cause a variety of maculopathies that can reduce central vision permanently. Although vision may improve spontaneously, most cases require intervention. Unrestricted access to commercially available high-power handheld laser devices is dangerous and public awareness should be encouraged.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Epiretinal Membrane / diagnosis
  • Epiretinal Membrane / etiology*
  • Epiretinal Membrane / surgery
  • Fluorescein Angiography
  • Hospitals, Special
  • Humans
  • Lasers / adverse effects*
  • Lasers, Solid-State / therapeutic use
  • Male
  • Ophthalmology
  • Retina / radiation effects*
  • Retinal Hemorrhage / diagnosis
  • Retinal Hemorrhage / etiology*
  • Retinal Hemorrhage / surgery
  • Saudi Arabia
  • Tomography, Optical Coherence
  • Visual Acuity / physiology
  • Vitrectomy
  • Vitreous Hemorrhage / diagnosis
  • Vitreous Hemorrhage / etiology*
  • Vitreous Hemorrhage / surgery
  • Young Adult