Editor,—A 30-year-old physics scientist looked accidently with his left eye directly into the path of a 1.064 nm Nd:YAG laser beam. The laser variables were not known. He experienced a dramatic decrease in vision in this eye. Upon examination at the local hospital, the patient’s corrected vision was 0.16 for the left eye, the intraocular pressure (IOP) was within normal range, and the cornea and lens were unremarkable. On funduscopy, an obvious retinal defect, partially covered with blood, was observed in the region of the fovea. Vitreal bleeding could be seen above the temporal inferior vessel arcade. The ophthalmic examination of the right eye was unremarkable.

Initially, the patient was treated with high dose corticosteroids and acetazolamide. Ten days after the accident, he was transferred to our department for evaluation. At this time the corrected vision in the patient’s left eye with eccentric fixation was 0.2. A well defined circular macular hole (approximate diameter 300 nm) with upright edges was observed; its centre corresponded exactly with the foveola (Fig 1). The vitreal haemorrhage had decreased considerably.