Санкт-Петербургский филиал ФГАУ «МНТК «Микрохирургия глаза» им. акад. С.Н. Фёдорова» Дата поступления: 07.09.2016 Статья принята к печати: 24.11.2016 Субпороговая микрофотокоагуляция (MicroPulse) приводит к появлению плохо различимых или невидимых ожогов сетчатки и зарекомендовала себя как эффективный метод в лечении диабети-ческого макулярного отёка при отсутствии побочных эффектов, свойственных методике ETDRS (атрофия пигментного эпителия и сосудистой оболочки, снижение чувствительности сетчатки). Эффективность микрофотокоагуляции может быть повышена при более плотном нанесении ла-зерных аппликаций, однако в современной литературе этому вопросу посвящены единичные пу-бликации. Ключевые слова: диабетическая макулопатия; диабетическая ретинопатия; сахарный диабет 2-го типа; микрофотокоагуляция; околосубпороговая лазерная коагуляция. Subthreshold microphotocoagulation (MicroPulase) leads to development of barely visible or invisible retinal burns and has been shown to be effective in macular edema treatment without any side effects inherent to the ETDRS method (atrophy of retinal pigment epithelium and choroid, decrease of retinal sensitivity). Microphotocoagulation efficacy may be increased by high density laser applications, however in modern literature rare publications draw attention to this matter.
COMPARATIVE ESTIMATION OF LASER COAGULATION EFFICIENCY IN MACULAR AND MICROPHOTOCOAGULATION OF HIGH DENSITY IN DIABETIC MACULOPATHY TREATMENT
The modern standard of treatment of clinically significant diabetic macular edema is macular laser photocoagulation was suggested in the reports of the Early Treatment of Diabetic Retinopathy Study (ETDRS, 1985-1990). Subthreshold microphotocoagulation (MicroPulase) leads to developing barely visible or invisible retinal burns and also has been shown to be effective in treating macular edema with no side effects comparing with ETDRS methodic (retinal pigment and choroidal atrophy, decreasing of retinal sensitivity). Effectiveness of microphotocoagulation may arise in high density laser applications, however in modern literature exists rare publications concerning this question.
Introduction. The threshold laser coagulation leads to irreversible damage of retinal structures, microscotomata appearance in the central visual field, contrast sensitivity decrease, and color vision impairment, being accompanied as well by the release of proinflammatory cytokines. For diabetic macular edema treatment, a method of high-density subthreshold laser coagulation (810 nm) was first developed, based on individualized choice of subthreshold parameters of laser irradiation, and permitting confluent application of laser impacts to the retina. Using multimodal diagnostic approach to the estimation of anatomic and functional treatment results, a minimally invasive character and safety of this DME treatment method were confirmed.
Purpose. The aim of this study was to comparatively evaluate the efficacy of a diode laser (810 mn) subthreshold laser treatment using high-density laser impact application in diode laser coagulation (DLC) and diode microphotocoagulation (DMP) modes.
Materials and methods. To compare the efficacy of subthreshold laser treatment methods (DLC and DMP), patients were divided into two groups, comparable in macular edema thickness and area. The first group (24 eyes) received a macular laser coagulation in grid pattern and MicroPulse diode laser (810 nm) regimen; biomicroscopically it was predominantly subthreshold high-density application of burns. The second group (29 eyes) received a macular laser coagulation in grid pattern and continuous diode laser (810 nm) regimen; biomicroscopically it was predominantly subthreshold high-density application of burns.
Results. After DLC and DMP, there was no statistically significant difference between compared groups in best corrected visual acuity. There was also no significant difference in retinal edema maximal height dynamics, retinal edema area, and central thickness in 2 and 4 months.
Conclusion. Subthreshold microphotocoagulation and laser coagulation methods at the same average power of laser exposure and other exposure parameters in the shortterm follow-up have comparable efficacy in the treatment of diabetic macular edema.
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