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H. D. Hacker, J. Brown, Jr., J. Lund, H. Zwick, R. Cheramie, B. Stuck; Optical Coherence Tomography in the Evaluation of Human Femtosecond Laser Eye Injury. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2576.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the effectiveness of optical coherence tomography (OCT) as a diagnostic technique in the evaluation of patients with accidental laser eye exposure incidents while adjusting a laser in a laboratory environment.
Two patients were evaluated post accidental laser exposure of the retina from a pulsed Ti:saph femtosecond laser operating at 800 nanometers. Clinical testing and correlation of findings was performed utilizing sequential measurements of Snellen visual acuity and optical coherence tomography. Digital color photography and fluorescein angiography were also employed to assess the progression of these lesions and response to therapy.
In both cases, the patients were evaluated on the day of the injury and followed for three to six months. On presentation, these patients showed mild decrease in visual acuity to the 20/30- level in the affected eyes. Digital color images clearly disclosed the parafoveal location of the laser exposures with blanching of the underlying retinal pigment epithelium. No evidence of associated retinal hemorrhage or physical disruption of the retina was evident on these images. Despite the obvious findings noted on color imagery, fluorescein angiography did not show evidence of leakage or staining in the vicinity of the laser lesions. OCT was then obtained with operator guidance to assess the structural changes in the retinal tissues surrounding the laser lesions. OCT studies on the day of injury showed disruption of the retinal pigment epithelial layer with increased signal return in the cross-sectional area of the injury suggesting retinal edema and disturbance of the retinal architecture. Follow-up OCT scans showed resolution of these changes at one month with return of visual acuity to the 20/20- level at that time. These improvements remained stable on subsequent examinations.
OCT continues to gain wide acceptance in clinical ophthalmology for the early and rapid diagnosis of a variety of pathologies that affect the retina. OCT was uniquely able to clearly delineate the effects of laser retinal injury that went undetected by fluorescein angiography.
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