Original Article
Improved Diagnosis of Retinal Laser Injuries Using Near-Infrared Autofluorescence

https://doi.org/10.1016/j.ajo.2019.06.001Get rights and content

Purpose

To assess whether near infrared autofluorescence (NIR-AF) imaging is a useful imaging modality in the diagnosis of handheld laser retinal injuries.

Design

Retrospective observational case series.

Methods

Twelve patients identified to have handheld laser retinal injuries were included at 2 academic centers. Patients underwent ophthalmic assessment and retinal imaging including fundus photography, optical coherence tomography (OCT), conventional blue autofluorescence (B-AF), and NIR-AF imaging.

Results

In all cases, lesions consistent with retinal laser injury were detected by NIR-AF imaging. The lesions showed a characteristic appearance with central hyperfluorescence and surrounding hypofluorescence, although the number and extent of lesions varied between patients. Findings using other imaging modalities were variable: on color fundus photography these included localized pigmentary changes and on OCT imaging an ellipsoid zone interruption or outer nuclear layer changes. Only subtle changes were evident on B-AF imaging. Other macular conditions, such as poppers retinopathy or solar maculopathy, which may have similar findings on OCT imaging as laser damage, can be differentiated using NIR-AF imaging.

Conclusion

An increased incidence of retinal injuries secondary to handheld lasers has been reported in recent years. We show that the diagnosis and full extent of retinal laser injuries is best demonstrated by NIR-AF, as other modalities give variable results. We propose that NIR-AF should be included when investigating patients suspected of macular injury secondary to exposure to handheld lasers.

Section snippets

Methods

In this retrospective observational case series, patients with inadvertent retinal laser damage seen at 2 academic centers (Oxford Eye Hospital, Oxford, UK and the Department of Ophthalmology, University of Bonn, Bonn, Germany) were identified from their medical records. The standard imaging protocol for patients with retinal light damage included B-AF (excitation at 488 nm, barrier filter at 500 nm) and NIR-AF (excitation at 787 nm, barrier filter at 810 nm) imaging (HRA2; Heidelberg

Results

We identified 12 patients with a clinical diagnosis of retinal laser injury, 9 of whom confirmed a history of laser exposure (Table). Owing to bilateral involvement in 2 patients, 14 eyes were available for analysis. Eight patients were male, 4 were female; and mean age at presentation was 13.9 years ± 2.9 years standard deviation (range: 9-20 years). At initial presentation, 5 patients reported a central scotoma and 2 described blurred vision. Five patients reported no vision problems

Discussion

In this series, we demonstrate that NIR-AF imaging consistently reveals typical sharply demarcated, often grouped lesions in patients with retinal injuries confirmed to have had prior exposure to handheld lasers. Features on other imaging modalities including conventional color fundus photography, B-AF, and OCT were less consistent or specific. This characteristic appearance on NIR-AF may help in diagnosing patients who do not recall laser exposure and help differentiate other disease entities

Summary

NIR-AF imaging is useful for determining the pattern and extent of laser damage. Characteristic features on NIR-AF imaging may be of diagnostic value for differentiating retinal lesions with a similar appearance on other imaging modalities, and for identifying laser injuries where retinal changes are otherwise minimal and/or less specific. We recommend including NIR-AF imaging for all patients suspected of retinal laser injury, and for those in whom it is included in the differential diagnosis,

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