[Retinal reactions to intense light. I. Threshold lesions. Experimental, morphological and clinical studies of pathological and therapeutic effects of laser and white light]

Abstract

The effects of intense light produced by an argon laser, a helium-neon laser and a xenon are photocoagulator in the retinas of gray chinchilla rabbits, cynomolgus monkeys, and rhesus monkeys were studied clinically and histopathologically including electron microscopy. An improved experimental set-up was used allowing a very good consistency of the inflicted lesions. Threshold lesions were produced in chinchilla rabbits and cynomolgus monkeys by an argon laser and a helium-neon laser. The lesions were evaluated ophthalmoscopically and histograms were drawn indicating ophthalmoscopic ED50 values. For the two lasers examined these values were 12 and 17 mW, respectively, for exposure durations in the range of the blink reflex (125-150 msec). Histopathologically, ophthalmoscopic threshold lesions of both laser types showed evidence of thermal damage of the outer retinal half. This damage was principally identical in both species involving the retinal pigment epithelium and the full extension of the photoreceptor cells up to their synapses within the outer plexiform layer. The ophthalmoscopic threshold value was associated, therefore, with an irreversible loss of visual function within the retinal area concerned. No evidence for primary sites of significant energy absorption within the neural retina was found. The width of ophthalmoscopic threshold lesions was determined by measuring within the histologic sections with a microscope and a calibrated graticule the extension of damage at the level of the retinal pigment epithelium and at the level of the outer nuclear layer. In the cynomolgus monkey for ophthalmoscopic argon laser threshold lesions the extension at the level of the RPE was 70-80 mum in diameter and at the level of the outer nuclear layer it was 40-50 mum in diameter. Laser lesions that had a diameter of 60 mum at the level of the RPE and of 30 mum at the level of the outer nuclear layer were ophthalmoscopically subvisible. It is concluded that probably also in man such laser lesions, as well as various other pathologic changes of this size or smaller, cannot be evaluated by clinical ophthalmoscopy. The ophthalmoscopic threshold was correlated with a histopathologic threshold as defined by minimal histopathologic damage. Very likely, such damage lies within the range of functional recovery, and the histopathologic threshold demarcates at the same time the decisive functional threshold. The conversion ratio between histopathologic-functional and ophthalmoscopic threshold for argon lesions in cynomolgus monkeys was somewhat greater than 3, e.i. the ophthalmoscopic threshold was more than 3 times higher than the histopathologic-functional threshold. Using this data together with additional biologic and optical considerations, a safety threshold for man for cw-lasers within the visible spectrum was estimated to be 1-2 mW.