PMC5088445_01
Funduscopic findings at presentation as documented via multimodal imaging. a Color photograph of the right eye taken 1 day after the injury shows sharply demarcated, "excavated" green-grey lesions with yellow borders situated in a vertical-oblique fashion in the central macula. b Fundus autofluorescence taken 1 day after the injury shows central hyperfluorescence of the lesions with a thin surrounding rim of hyperautofluorescence. c Spectral domain optical coherence tomography images of three different sections taken 1 day after the injury show curvilinear bands of dense hyperreflectivity that extend from the interdigitation layer and ellipsoid zone of the photoreceptors upwards, ending at the level of the outer plexiform layer. The hyperreflective lesions appear to follow the Henle fibers. There are small hyporeflective cavities beneath the fovea. d Fluorescein angiography taken 1 day after the injury shows hyperfluorescence of the lesions with minimal leakage. An additional satellite lesion, not detected with color photos and autofluorescence, is evident nasal to the fovea. e Photograph of the device used in the injury with a magnified view (inset) of its label
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Fig1
Funduscopic examination of the right eye revealed several sharply demarcated lesions with an excavated appearance, yellowish borders, and grey-green centers (Fig. 1a). Fundus autofluorescence showed lesions that co-localized with the lesion seen in the color photographs (Fig. 1b). An additional lesion, invisible on exam, was evident nasal to the fovea (Fig. 1d). SD-OCT performed 1 day after the injury showed curvilinear bands of dense hyperreflectivity that extended from the interdigitation layer and ellipsoid zone of the photoreceptors upwards, ending at the level of the outer plexiform layer (Fig. 1c). Thus, the laser pointer was incorrectly labeled as "Class III Laser Product" (Fig. 1d) when, as per the above measurements, it should have been classified as a Class IIIB laser, which requires a key switch and a safety interlock.
MultiColor and spectral domain optical coherence tomography findings obtained 7 days following the injury. The lesions are not seen with blue-reflectance but become increasingly apparent with the longer green and infrared reflectance wavelengths. Note that while the multicolor image sharply depicts the borders of the lesions, it may misrepresent the true color of their center as seen on funduscopy. Three SD-OCT scans through the central macula show that the vertical curvilinear hyperreflective bands are attenuated 7 days after the initial injury
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Fig2
MultiColor and SD-OCT findings taken 7 days following the onset of symptoms are shown in Fig. 2.
Evolution of the spectral domain optical coherence tomography: findings over 3 months. Eye-tracked, subfoveal SD-OCT line scans of the right eye are shown. The scans were taken at 1 day, 4 days, 2 weeks, 1 month and 3 months after the onset of the patient's visual symptoms. Note how quickly the vertical curvilinear bands of hyperreflectivity resolve
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Fig3
The evolution of the SD-OCT findings was documented over 3 months of follow-up (Fig. 3).
The 3 month visit findings as documented by multimodal imaging. a Color photograph of the right eye shows that the lesions now demonstrate central pigment hyperplasia with some surrounding depigmentation. Inset Microperimetry shows persistent central scotomas and slightly eccentric fixation. Visual acuity is 20/30 in the right eye. b Fundus (488 nm) autofluorescence shows near normalization of the acute changes and underappreciation of the lesion boundaries in comparison with the infrared image. c Infrared reflectance image shows high reflectivity of the macular lesions
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Fig4
Funduscopic examination of right eye showed central pigment hyperplasia with some surrounding depigmentation of the lesions in the macula (Fig. 4a). Fundus autofluorescence showed near normalization of the acute changes (Fig. 4b), but the size of the lesions on this modality was observably smaller than the infrared reflectance image (Fig. 4c). Microperimetry showed persistent central scotomas and slightly eccentric fixation (Fig. 4d).    