This retrospective observational case series aimed to assess whether near infrared autofluorescence (NIR-AR) imaging is a useful imaging modality in the diagnosis of hand-held laser retinal injuries. Twelve patients from two centres underwent ophthalmic assessment and retinal imaging including fundus photography, optical coherence tomography (OCT), conventional blue autofluorescence (B-AF) and NIR-AF imaging. Nine patients had a confirmed history of laser exposure and as two patients were bilateral 14 eyes were available for analysis. Patients’ symptoms were varied. Five patients complained of a central scotoma, two patients of blurred vision and five patients had no visual problems but had macular changes detected by the optician on a routine review. In all cases lesions consistent with retinal injury were detected by NIR-AF. These lesions showed a characteristic appearance with increased signal in the centre of the lesion, which often corresponded to small areas of hyperpigmentation on fundoscopy, with surrounding reduced signal. With the other imaging modalities, findings were much more variable, some showing minimal pigmentary change and focal hypo- and hyper pigmentation in others. In particular on B-AF imaging, either no obvious abnormality was seen or very mild changes only. This study therefore has proposed that the best way to assess those patients suspected of having a retinal laser injury and for those in whom it is included in a differential diagnosis is using NIR-AF. However, due to the retrospective nature of this study the patients had varying time from injury when they were examined and this was not done in a standardised manner, larger and more robust studies are required.

Improved diagnosis of retinal laser injuries using near-infrared autofluorescence.
De Silva SR, Neffendorf JE, Birtel J, et al.
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Tasmin Berman

University of Liverpool, Liverpool, UK.

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