Vitrectomy for macular hole following Nd:YAG laser injury

The Q-switched Nd:YAG laser can cause significant ocular injury, because it can emit an invisible and powerful load of energy in a short period of time. One of these injuries is macular hole formation. We report the case of a 21-year-old woman who presented with acute floaters in her left eye after exposure to a Q-switched Nd:YAG laser. Her initial best-corrected visual acuity (BCVA) in the left eye was 20/80. Examination demonstrated an acute vitreous hemorrhage, and spectral-domain optical coherence tomography (SD-OCT) confirmed a full-thickness macular hole (FTMH). Four months after her injury, her BCVA deteriorated to 20/400, and she underwent vitrectomy, internal limiting membrane peeling, and gas injection. Three weeks following the procedure, her FTMH was closed, however, her BCVA remained 20/150. At her last office visit, 19 months after the surgery, the examination was unchanged. There are few reports of vitrectomy to close an FTMH after Nd:YAG laser exposure, and the factors that contribute to visual recovery remain unclear. The aim of this case report is to emphasize the importance of early diagnosis and surgical repair, and to review the literature and surgical outcomes of cases of Nd:YAG laser-induced macular holes. Imaging with SD-OCT was essential in evaluating the visual outcome, as it was dependent on the degree of photoreceptor and retinal pigment epithelium injury.