Periocular CO2 laser resurfacing: severe ocular complications from multiple unintentional laser impacts on the protective metal eye shields

Martin J.C. van Gemert, Paul R. Bloemen, Wei-Yong Wang, C.W.M. van der Geld, Rudy M.M.A. Nuijts, Hayri Hortoglu, Albert Wolkerstorfer, Daniel Martijn de Bruin, Ton G. van Leeuwen, H.A. Martino Neumann, Martine J. Jager

Research output: Contribution to journalArticleAcademicpeer-review

13 Citations (Scopus)
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Abstract

Background and Objectives: A 36-year-old woman underwent CO 2 laser resurfacing for periocular rhytides using protective stainless steel Cox II ocular shields. Immediately after the treatment, corneal lesions were seen in both eyes. The left eye subsequent developed corneal ulceration and scarring, a deformed iris, cataract, and lower eye lashes showing signs of acute burns. The right cornea had a small inferior mid-peripheral superficial lesion and concomitant lower mid-peripheral burned eye lashes. Our objective was to determine the most likely cause of these ocular complications. Study: We estimated temperature–time combinations that could induce corneal injury and cataract. Heat conduction effects from a heated cornea to the lens and from a heated ring of periocular skin to the cornea were computed. The temperature response of a shield following CO 2 laser irradiation was determined. Results: We computed that cataract can develop when the corneal temperature reaches, for example, 80 °C for 14 seconds. A periocular ring of heated skin contributes little to the corneal temperature. After 7 pulses of consecutive CO 2 laser bursts in 7.5 seconds, the total shield area already reached a homogeneous temperature of 63 °C. Conclusion: Despite uncertainties in procedural details and modeling of cataract temperatures, the eye injuries were caused beyond doubt by heating of tear-covered metal eye shields by at least 10 consecutive but unintentional laser impacts. Lasers Surg. Med. 50:980–986, 2018.

Original languageEnglish
Pages (from-to)980-986
Number of pages7
JournalLasers in Surgery and Medicine
Volume50
Issue number10
Early online date8 Jun 2018
DOIs
Publication statusPublished - 1 Dec 2018

Keywords

  • CO laser
  • burned eye lashes
  • corneal melting
  • metal eye shields
  • ocular complications
  • periocular skin resurfacing
  • temperature–time predictions of cataract formation
  • Humans
  • Cataract/etiology
  • Hot Temperature
  • Rhytidoplasty/adverse effects
  • Carbon Dioxide
  • Eye Protective Devices/adverse effects
  • Lasers, Gas
  • Corneal Injuries/etiology
  • Laser Therapy/adverse effects
  • Stainless Steel
  • Adult
  • Female

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