Management of Spots After Peripheral Retinal Photocoagulation
Spots appearing in the peripheral retina immediately after photocoagulation are likely retinal burns, which are an expected outcome of the laser treatment and do not require additional intervention.
Understanding Retinal Burns After Photocoagulation
Retinal photocoagulation is a laser procedure commonly used to treat various retinal conditions, including:
- Proliferative diabetic retinopathy (PDR)
- Branch or central retinal vein occlusions
- Retinal tears or lattice degeneration
During photocoagulation, the formation of a vaporization bubble immediately after laser application indicates successful treatment, correlating with the intended therapeutic effect 1. These spots are expected and represent the desired outcome of treatment.
Characteristics of Normal Post-Photocoagulation Burns
- Appear immediately after the procedure
- Located in the peripheral retina (lattice areas)
- Initially appear as yellowish RPE depigmentation after 1 day
- May become hyperpigmented areas after 3 months, though many become less visible over time 2
- Correspond to localized increased optical reflectivity within the outer retina on OCT imaging 3
Monitoring and Follow-up
- No specific intervention is needed for expected retinal burns in the periphery
- Regular follow-up is recommended to ensure proper healing
- Fundus autofluorescence (AF) can be used to visualize complete treatment arrays, showing hypoautofluorescence at laser burn sites immediately after treatment, changing to hyperautofluorescence after 1 week 3
- OCT can confirm that burns are limited to the intended retinal layers
When to Be Concerned
Additional evaluation may be warranted if:
- Spots appear in untreated areas
- Spots are associated with new visual symptoms beyond what is expected
- Vitreous hemorrhage develops
- There are signs of retinal detachment
Histopathologic Understanding
The appearance of spots after photocoagulation represents the intended therapeutic effect:
- Mild burns spare inner retinal cellular elements
- Moderate burns affect deeper layers
- Severe burns can cause full-thickness retinal cell loss 4
Burns typically "bloom" during the several seconds following laser application, indicating deep energy absorption 4. This is normal and expected.
Conclusion
Peripheral retinal spots appearing immediately after photocoagulation represent the intended therapeutic effect of the treatment and do not require additional intervention. These spots are part of the normal healing process and will evolve over time, typically becoming less visible as healing progresses.