Autofluorescence imaging after selective RPE laser treatment in macular diseases and clinical outcome: a pilot study
Open Access
- 1 October 2002
- journal article
- research article
- Published by BMJ in British Journal of Ophthalmology
- Vol. 86 (10), 1099-1106
- https://doi.org/10.1136/bjo.86.10.1099
Abstract
Aim: Selective retinal pigment epithelium (RPE) laser treatment is a new technique which selectively damages the RPE while sparing the neural retina. One difficulty is the inability to visualise the laser lesions. The aim of the study was to investigate whether fundus autofluorescence (AF) is changed because of the RPE damage, and thus might be used for treatment control. Additionally, the clinical course of patients with various macular diseases was evaluated. Methods: 26 patients with macular diseases (diabetic maculopathy (DMP), soft drusen maculopathy (AMD), and central serous retinopathy (CSR)) were treated and followed up for at least 6 months. Treatment was performed with a train of repetitive short laser pulses (800 ns) of a frequency doubled Nd:YAG laser (parameters: 532 nm, 50 and 500 pulses at 100 and 500 Hz, retinal spot diameter 200 μm, pulse energies 75–175 μJ). AF was excited by 488 nm and detected by a barrier filter at 500 nm (HRA, Heidelberg Engineering, Germany). Patients were examined by ophthalmoscopy, fluorescein angiography, and autofluorescence measurements at various times after treatment (10 minutes, 1 hour, 1 and 6 weeks, 3, 6, and 12 months). Results: Fluorescein angiography showed leakage from the irradiated areas for about 1 week after treatment. None of the laser lesions was ophthalmoscopically visible during treatment. Identification of the lesions was possible by AF imaging showing an intensity decay in the irradiated area in 22 out of 26 patients, predominantly in patients with CSR and AMD. Lesions could be identified 10 minutes after treatment as hypoautofluorescent spots, which were more pronounced 1 hour later. During follow up the laser spots became hyperautofluorescent. In patients with DMP some AF images were less helpful because of diffuse oedema and larger retinal thickness. In these cases ICG angiography was able to confirm therapeutic success very well. Most of the patients have had benefit from the treatment, with best results obtained for CSR patients. Conclusion: Imaging of non-visible selective RPE laser effects can be achieved by AF measurements predominantly in patients without retinal oedema. Therefore, AF may replace invasive fluorescein angiography in many cases to verify therapeutic laser success. Selective laser treatment has the potential to improve the prognosis of macular diseases without the risk of laser scotomas.Keywords
This publication has 30 references indexed in Scilit:
- Subthreshold (retinal pigment epithelium) photocoagulation in macular diseases: a pilot studyBritish Journal of Ophthalmology, 2000
- Distribution of fundus autofluorescence with a scanning laser ophthalmoscope.British Journal of Ophthalmology, 1995
- Response of the Retinal Pigment Epithelium to Selective PhotocoagulationAmerican Journal of Ophthalmology, 1992
- Relationship of Drusen and Abnormalities of the Retinal Pigment Epithelium to the Prognosis of Neovascular Macular DegenerationAmerican Journal of Ophthalmology, 1990
- Response of Pig Retinal Pigment Epithelium to Laser Photocoagulation in Organ CultureAmerican Journal of Ophthalmology, 1989
- Cellular Processes Causing Defects in Bruch's Membrane Following Krypton Laser PhotocoagulationOphthalmology, 1986
- Repair of the Pigment Epithelial Barrier Following PhotocoagulationAmerican Journal of Ophthalmology, 1984
- A comparative histopathological study of argon and krypton laser irradiations of the human retina.British Journal of Ophthalmology, 1979
- Histology of retinal lesions produced with Q-switched lasersExperimental Eye Research, 1968
- Stimulated Optical Radiation in RubyNature, 1960