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Impressum
Autofluorescence imaging after selective RPE laser treatment of macular diseases
1Framme C., 2Schüle G., 2Birngruber R., 2Brinkmann R., 1Roider J.
1University Eye Clinic Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg; 2Medical Laser Center Lübeck, Peter-Monnik-Weg 4, Lübeck
Objective: Selective RPE laser treatment is a new technique, which
selectively damages the RPE and avoids adverse effects to the neural retina.
A problem is the non-visibility of the subtreshold laser lesions. The
aim of the study was to investigate whether fundus-autofluorescence (AF),
which is derived from the lipofuscin contained by the RPE cells, is changed
due to the RPE damage, and thus may be used for non-invasive treatment
control.
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 six months. Treatment was performed
with a train of repetitive short laser pulses (800ns) of a green Nd:YAG
laser (parameters: 532nm, 100 and 500 pulses at 500Hz, retinal spot diameter
200µm, pulse energies 70 - 175µJ). AF was excited by 488nm
and detected by a barrier filter at 500nm (HRA, Heidelberg engineering).
Patients were examined by ophthalmoscopy, fluorescein-angiography and
autofluorescence measurements various times after treatment (10 minutes,
1 hour, 1,6 weeks, 3,6,12 months).
Results: Fluorescein angiography showed leakage of the irradiated
areas for about one week. 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 due to diffuse edema and larger retinal thickness.
Conclusion: Imaging of non-visible selective RPE laser effects
can be achieved by AF measurements predominantly in patients without retinal
edema. Therefore AF may replace invasive fluorescein-angiography in most
cases to verify therapeutic laser success.