Peripapillary retinal thermal coagulation following electrical injury
A 20 year old boy presented to our department with decreased vision, redness and watering of both eyes following electrocution with overhead transmission wires six days ago. The electricity transmission wires were carrying a high voltage of approximately 20,000V. He had multiple eschars on the back, scalp and arms along with facial erythema []. His best-corrected visual acuity was light perception in the right eye and counting fingers in the left eye with normal intraocular pressures. There was a lid scaling and charring of the eyelashes. Anterior segment examination showed bilateral circumcorneal congestion, sluggish pupillary reactions, superficial punctate keratitis and cataract in the left eye. Fundoscopy revealed an area of peripapillary retinal opacification and a dull foveal reflex in both eyes [Figs. and ]. Fundus fluorescein angiogram showed a normal retinal circulation with late hyperfluorescence corresponding to the area of opacification. Optical coherence tomography (OCT) showed retinal thickening with few cystoid spaces in the right eye []. Similar changes were seen the left eye (not shown). Patient was started on oral corticosteroids (prednisolone 30 mg/day) and acetazolamide (750 mg/day in three divided doses). Steroids were given to control inflammation arising from the injury, if any, and oral carbonic anhydrase inhibitor were added to reduce cystic fluid collection by possible stimulation of the retinal pigment epithelium (RPE) pump.[] Acetazolamide was withdrawn after 1 month and oral steroids were discontinued after another month by gradual tapering. One month later, his best corrected visual acuity was counting fingers 1 meter in the both eyes with posterior subcapsular cataract and peripapillary retinal atrophy in both the eyes []. OCT of both the eyes showed retinal atrophy with disorganization of all retinal layers and the RPE []. Patient underwent cataract surgery after 6 months from the time of injury in both the eyes with no improvement in the visual acuity.