Complete visual recovery after an inadvertent foveal burn

Abstract

We want to describe a case of inadvertent foveal burn during retinal laser in a patient with proliferative diabetic retinopathy (PDR). We report a 50-year-old male with PDR whose pattern scanning laser (Pascal®) procedure was complicated by an accidental foveal burn. On initial evaluation, the best-corrected visual acuity of the affected eye was 20/40. Fundoscopy revealed multiple laser burns in the macula, one of which crossed the fovea. The optical coherence tomography (OCT) showed an inadvertent burn at the foveal region and multiple parafoveal laser spots with the disrupted corresponding external limiting membrane (ELM), ellipsoid (EZ), and interdigitation zones. The patient underwent serial follow-up examinations. Six months after laser therapy, vision significantly recovered and improved to 20/20 in the affected eye. The results of follow-up OCT imaging showed that the ELM defect had fully recovered and the EZ defect had become smaller, as an unexpected and rare outcome. As a rare and interesting condition, laser burns around the foveal region seem to have the chance of retinal recovery over time. However, in most of the similar conditions, these accidental foveal laser burns lead to permanent severe visual impairment. Therefore, well-trained physicians must do retinal laser procedures.