Chorioretinal anastomosis secondary to inadvertent alexandrite laser exposure

Alexandrite laser is generally used for hair removal and treatment of hyperpigmented skin lesions. It is important to use protective equipment during treatment. In previous cases, complications such as conjunctival hyperemia, anterior uveitis, and choroidal neovascularization were reported. We report a case who developed chorioretinal anastomosis secondary to inadvertent alexandrite laser exposure.

A 44 year-old woman presented with decrease of vision in the left eye. She had an history of alexandrite laser treatment for facial hair removal two weeks ago. Fundus examination of the left eye revealed an elevated yellowish lesion in the temporal macula and retina pigment epithelium (RPE) atrophy was observed in the inferotemporal perifoveal region. Optical coherence tomography (OCT) of the left eye revealed the disorganization of inner and outer retinal layers, a rupture in the Bruch membrane, and an absence of RPE. Fluorescein angiography images showed early hyperfluoresence inferior to the fovea. OCT angiography revealed an abnormal vascular network between deep retina layers and choroid. B-scan with flow overlay demonstrated the blood flow in the abnormal vascular network which is suggestive of chorioretinal anastomosis. The patient was followed monthly for choroidal neovascularization development. Six months after laser exposure the best corrected visual acuity was partially improved in the left eye and fundus examination showed pigmentary changes.

Chorioretinal anastomosis may rarely develop secondary to inadvertent alexandrite laser treatment. It is important to use protective equipment during treatment to prevent ophthalmological complications.