Hazards of laser beam reflections in eyes containing gas

Three patients suffered photic or thermal laser injuries at unintended sites because of reflection from gas-fluid interfaces in eyes containing gas. Fresnel's equations predict the amount of light transmitted or reflected at optical interfaces. Application of Fresnel's equations demonstrate that significant laser reflection occurs at gas-fluid or fluid-gas interfaces, especially at high angles of incidence. Photocoagulation across gas-fluid or fluid-gas interfaces should be avoided to reduce the risk of unintended damage from reflected light. If photocoagulation must be performed across an interface, the surgeon should minimize the angle of incidence of the treatment laser beam, use a divergent beam, and consider the location and intensity of the reflected beam. Because of the higher phototoxicity of blue light, photocoagulation with blue-green lasers across gas-fluid or fluid-gas interfaces is undesirable. Proper polarization of the treatment laser beam may significantly reduce laser reflectance.