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Reversible structural disruption of the outer retina in acute welding maculopathy

Sir,

Exposure to welding arcs might result in maculopathy if appropriate protective eyewear is not used. The damage is thought to stem from photochemical injury to the photoreceptors.1, 2 We report the correlation of clinical and optical coherence tomography (OCT) findings in a case of acute welding maculopathy.

Case report

A 19-year-old male presented with blurred vision in his right eye after staring at a welder earlier that day. The patient was aphakic in both eyes after lensectomy at the age of 10 years for subluxated microspherophakic lenses. Corrected visual acuity 3 months before presenting to our clinic was 6/7.5 in the right eye. Visual acuity in the left eye was light perception as a result of recurrent rhegmatogenous retinal detachment after trauma and development of proliferative vitreoretinopathy. On presentation, best-corrected visual acuity in the right eye was 6/30. Slit-lamp examination of the right eye revealed aphakia and iridectomy. Ophthalmoscopy revealed a dark-red foveal lesion (Figure 1a) in the right eye, whereas fluorescein angiogram appeared normal. OCT (STRATUS OCT™ Model 3000, Carl Zeiss Meditech Technologies) demonstrated disruption of all foveolar layers (Figure 1b). The patient showed gradual improvement in his vision, and 1 month following presentation, an OCT demonstrated normal appearance of the inner foveolar layers while the outer segments still appeared disrupted (Figure 1c). Five months following the injury, visual acuity in the right eye recovered to 6/7.5, and OCT image appeared normal (Figure 1d), but ophthalmoscopy still demonstrated discoloration of the macula.

Figure 1
figure1

(a) Colour fundus photograph of the right eye at presentation showing darkish foveal lesion. (b) OCT findings at presentation, (c) 1 month, and (d) 5 months following exposure to welding arc. Disruption of all foveal layers is seen following exposure (b), with gradual recovery starting at the inner layers (c), following by regaining of the normal OCT appearance of the fovea (d).

Comment

Photochemical retinal damage produced by welding arcs is thought to result from exposure to visible light, which can penetrate the cornea and lens, reaching the retina.2, 3 In aphakia, as in our case, wider spectrum of waves, and in particular damaging short wavelength radiation, may gain access to the retina and exacerbate the damage.

Although OCT findings in acute welding maculopathy have not been reported previously, Bechmann et al4 reported on transient hyper-reflective area involving all foveolar retinal layers in OCT obtained from a patient with early solar retinopathy, a condition in which photochemical injury is also thought to have a role. Thermal damage may also result in a similar hyper-reflective foveal lesion.5 Recent OCT findings in a report on chronic welding maculopathy documented permanent disruption of the foveal outer segment.2 Histopathologic studies of chronic solar maculopathy have demonstrated that most of the disruption occurs mainly in the pigment epithelium and outer segments of the photoreceptors.6, 7 An interesting speculation based on OCT findings in our case and in acute solar maculopathy is that acute photochemical injury may lead to reversible perturbation in photoreceptor outer segment renewal process. More extensive exposure might lead to permanent damage and chronic maculopathy.

References

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Correspondence to I Chowers.

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Vicuna-Kojchen, J., Amer, R. & Chowers, I. Reversible structural disruption of the outer retina in acute welding maculopathy. Eye 21, 127–129 (2007). https://doi.org/10.1038/sj.eye.6702443

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