Retinal injury by neodymium: YAG laser

Background: More than 85 cases of retinal laser injury were reported in the literature. Most of these cases involved direct exposure of the patient's retina to laser. The authors observed two patients who had laser injury to the retina caused by the reflected beams from a pulsed neodymium:YAG (Nd:YAG) laser. Methods: The clinical course of each patient after laser injury to the macular area with an Nd:YAG laser were followed for 21/2 and 31/2 months. Results: Both patients were graduate students and were injured by the reflected beams of short-pulsed Nd:YAG lasers (1064 nm) during experiments while wearing protective goggles for argon laser (465.9-514.5 nm). The affected eyes showed similar clinical courses with early subretinal/retinal/vitreous hemorrhage, resorption of blood, and subsequent macular pucker and macular hole formation, although the students' visual acuity improved. The unaffected eye of patient #2 showed chorioretinal scars, possibly from a previously unreported laser injury. Conclusion: The clinical courses of these two cases resembled earlier reported ones showing hemorrhage and subsequent macular pucker and macular hole formation. The two cases reflect the need for closer examination of the standard procedures in laser handling. Unintended laser injury to the retina may be higher than reported in workers handling lasers.