A retrospective analysis of presentation and outcomes in a cluster outbreak of non-occupational laser exposure retinopathy.

OBJECTIVE

To investigate and describe the clinical presentation and outcomes of a case series with possible retinal laser injury following recreational laser shows and assess their attributability to laser exposure.

DESIGN

Multi-center case series.

SUBJECTS: All consecutive eyes with reported laser exposure from recreational laser show and confirmed retinal injury presenting between May 2022 and April 2023.

METHODS

Data were collected including demographics, details of laser exposure, prior ophthalmic or significant past medical history, clinical presentation including visual acuity, fundus photography, optical coherence tomography (OCT) or fundus fluorescein angiography (FFA) if available, treatment used, and follow-up and final outcomes in terms of visual acuity and complications, if any. Fundus photographs and OCT images were analyzed.

MAIN OUTCOME MEASURES: Demographics of the cohort, presenting and final visual acuity, morphology of retinal injury on fundus photographs and OCT images, complications if any, regression analysis to test connections to known events.

RESULTS

The study included a total of 51 eyes of 51 patients, all of whom reported exposure to recreational laser shows. The mean LogMAR visual acuity at presentation was 1183 (SD 0.50). All the eyes had premacular hemorrhage of mean size 1.90 disc diameters (SD 1.29), while a dot of retinal whitening ("white spot") was observed within the parafoveal area in 13 eyes (32.5%). Laser hyaloidotomy was performed in 54.9% of eyes, while 45.10% were managed conservatively. The majority of eyes [22, 78.57%] showed complete drainage immediately after hyaloidotomy, while partial drainage occurred in six eyes (21.43%). Only two eyes (4.26%) exhibited small residual hemorrhage at the end of the three-month period. Final mean LogMAR visual acuity was 0.123 (SD 0.20). Complications included RPE changes and epiretinal membrane formation. The incidence of cases correlated well with significant cultural events.

CONCLUSION

The presentation in all eyes was strongly suggestive of laser injury. Even though the outcomes were favorable, complications were not uncommon. We strongly recommend the immediate introduction of regulatory measures and establishment of a monitoring framework for laser shows in India. We propose referring to these injuries as "non-occupational laser exposure retinopathy".