HIGH-POWERED BLUE-LIGHT LASER-INDUCED MACULOPATHY IN AN ADOLESCENT: MULTI-MODAL IMAGING, EVOLUTION, AND MANAGEMENT.

Purpose: To characterize evolution of macular injury from a high-powered blue handheld laser using multimodal imaging and describe successful surgical treatment.
Methods: Observational clinical case report.
Results: A 17-year-old boy presented with unilateral acute loss of vision with discrete white macular lesions, full-thickness disruption of retinal layers, and hyperreflective material at the fovea on optical coherence tomography caused by exposure to a 445 nm blue-light handheld laser with power up to 2,000 mW characterized as a Class IV laser. The injury evolved into an approximately 950-μm full-thickness macular hole 3 weeks later with visual acuity of 20/400. Vitrectomy and internal limiting membrane peel resulted in anatomic success and final vision at 4 months of 20/25.
Conclusion: High-powered lasers can induce significant disruption of retinal layers, inflammatory debris, and full-thickness macular holes with momentary exposure that, despite poor anatomic prognostic factors, can have successful surgical outcomes.