In-vivo imaging of photoreceptor structure and laser injury pathophysiology in the snake eye

Confocal scanning laser ophthalmoscopy (CSLO) combined with the high numerical aperture of the snake eye was used to evaluate laser injury at the photoreceptor and vascular retinal layers. An Argon laser source focused within a 35 micron retinal spot was used to produce a range of exposures from 152 to 1000 μjoules in the retinas of the Checkered Garter and Great Plains Rat snake. Anesthesia was induced with ketamine and xylazine. In vivo exposure sites measured post exposure showed unique photoreceptor damage characterized by surviving photoreceptors that were highly reflective and saturated, swollen and revealed more complex mode structure than normal photoreceptors when imaged under higher magnification. Evidence of oxidative stress was observed in photoreceptor cells peripheral to the lesion site as a late developing fluorescence (1-2 hour post exposure) following injection of Dichlorodihydrofluorescein diacetate, a marker of oxidative stress. At the anterior retina, acute exposure produced `sticky' blood cells, identified as leukocytes with Acridine orange. These findings indicate that laser retinal injury in large eyes, such as the human eye may involve pathophysiological cellular dynamics in both posterior and anterior retina and in normal retina adjacent to lesion sites. Photoreceptor movement outside the lesion site may relate to alterations in photoreceptor orientation and the efficiency of the photoreceptors quantal catch.