A Case of Green Laser Pointer-induced Atypical Impending Macular Hole Treated with Vitrectomy in a Pediatric Patient

Abstract

Purpose: To report a case of atypical impending macular hole induced by green laser pointer in a pediatric patient treated with vitrectomy.Case summary: A 13-year-old patient visited our clinic complaining of decreased visual acuity and upper visual field defect in the right eye after exposure to a green laser pointer. Her best corrected visual acuity was 20/200 in the right eye. Ultra-widefield fundus photography and optical coherence tomography showed pre-retinal hemorrhage and sub-internal limiting membrane hemorrhage involving the fovea. After 4 months of follow-up, the retinal hemorrhage was spontaneously resolved, however, atypical impending macular hole with intact overlying internal limiting membrane was observed on optical coherence tomography in the right eye. Regular follow-up was performed for spontaneous macular hole closure. After 8 months of follow-up, the base diameter of the macular hole increased on optical coherence tomography, accordingly, pars plana vitrectomy, internal limiting membrane peeling, and intravitreal perfluoropropane gas injection were performed in the right eye. After 1 month of the surgery, the macular hole was successfully closed and the best corrected visual acuity was 20/25 in the right eye.Conclusions: In pediatric patient, retinal hemorrhage can be caused by green laser pointer, which may be spontaneously resolved. However, delayed macular hole can occur, and surgical intervention might be helpful for successful anatomical closure and recovery of visual acuity.