TY - JOUR
T1 - Periocular CO2 laser resurfacing
T2 - severe ocular complications from multiple unintentional laser impacts on the protective metal eye shields
AU - van Gemert, Martin J. C.
AU - Bloemen, Paul R.
AU - Wang, Wei-Yong
AU - van der Geld, Cees W. M.
AU - Nuijts, Rudy M. M. A.
AU - Hortoglu, Hayri
AU - Wolkerstorfer, Albert
AU - de Bruin, Daniel M.
AU - van Leeuwen, Ton G.
AU - Neumann, H. A. Martino
AU - Jager, Martine J.
PY - 2018/12
Y1 - 2018/12
N2 - Background and ObjectivesA 36-year-old woman underwent CO2 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.StudyWe 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 CO2 laser irradiation was determined.ResultsWe computed that cataract can develop when the corneal temperature reaches, for example, 80 degrees C for 14 seconds. A periocular ring of heated skin contributes little to the corneal temperature. After 7 pulses of consecutive CO2 laser bursts in 7.5 seconds, the total shield area already reached a homogeneous temperature of 63 degrees C.ConclusionDespite 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. (c) 2018 Wiley Periodicals, Inc.
AB - Background and ObjectivesA 36-year-old woman underwent CO2 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.StudyWe 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 CO2 laser irradiation was determined.ResultsWe computed that cataract can develop when the corneal temperature reaches, for example, 80 degrees C for 14 seconds. A periocular ring of heated skin contributes little to the corneal temperature. After 7 pulses of consecutive CO2 laser bursts in 7.5 seconds, the total shield area already reached a homogeneous temperature of 63 degrees C.ConclusionDespite 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. (c) 2018 Wiley Periodicals, Inc.
KW - CO2 laser
KW - periocular skin resurfacing
KW - ocular complications
KW - temperature-time predictions of cataract formation
KW - corneal melting
KW - burned eye lashes
KW - metal eye shields
KW - CORNEAS
KW - DAMAGE
U2 - 10.1002/lsm.22951
DO - 10.1002/lsm.22951
M3 - Article
C2 - 29882233
SN - 0196-8092
VL - 50
SP - 980
EP - 986
JO - Lasers in Surgery and Medicine
JF - Lasers in Surgery and Medicine
IS - 10
ER -