Abstract
There has been a sharp rise of reported handheld laser-induced maculopathy (HLIM) cases over the past decade, a concerning trend that may continue due to unregulated online access to high power lasers. Though HLIM has distinct clinical features, not uncommonly it may masquerade as other retinal disorders. It is critical therefore to recognise the clinical and multimodal imaging characteristics of this important and potentially devastating condition. As HLIM patients are typically young, unique issues need to be considered, such as delayed presentation, difficult history, poor compliance and behavioural or psychiatric comorbidity. This article will review the clinical and diagnostic features of laser injury, with a special emphasis on the multimodal retinal findings. In addition, we present a unique case of HLIM, resembling the presentation of a placoid disease variant and illustrating choroidal ischaemia using advanced retinal imaging, that offers further insight into the mechanisms of laser injury and its complications. The issues addressed in this review aim to increase recognition of an increasingly important and trending condition with potentially profound visual complications.
摘要
在过去十年中, 手持式激光器所导致的黄斑病变 (handheld laser-induced maculopathy, HLIM)的病例急剧增长, 因为网上获取高功率激光不受管控, 这一令人担忧的趋势可能会持续下去。尽管HLIM有显著的临床特征, 与其它视网膜疾病相混淆的情况并不少见。因此认识到这一重要且具有潜在破坏性疾病的临床和多模式影像特征是至关重要的。由于HLIM患者通常都很年轻, 因此需要考虑一些特殊的问题, 如患者延迟就诊、病史欠缺、依从性差以及伴有行为或精神疾病。本文将对激光损伤的临床和诊断特征进行综述, 并着重介绍多模式影像成像技术的视网膜改变。此外, 我们介绍了一个独特的HLIM病例, 病变类似于一种丘疹样的表现, 另外我们利用先进的视网膜成像技术发现脉络膜缺血, 从而可以进一步深入了解激光损伤的机制及其并发症。这篇综述所探讨的问题旨在提高人们对一种发病率不断提升且具有潜在的严重视觉并发症的认识。
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Tran, K., Wang, D., Scharf, J. et al. Inner choroidal ischaemia and CNV due to handheld laser-induced maculopathy: a case report and review. Eye 34, 1958–1965 (2020). https://doi.org/10.1038/s41433-020-0830-3
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DOI: https://doi.org/10.1038/s41433-020-0830-3
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