Application of Micro-Pulse and Continuous Laser Radiation in Navigation Topographically-Oriented Treatment of Focal Diabetic Macular Edema Based

Abstract

Purpose: to evaluate the clinical efficacy of subthreshold laser treatment of focal DME in continuous and micro-pulse modes using a navigation system based on OCT-A data.Methods. 33 patients (33 eyes) with focal DME were under observation before and after laser treatment. All patients underwent high-resolution OCT-A using the HD Angio Retina 6×6 mm protocol on RTVue-100 XR Avanti (Optovue, USA) and SOLIX (Optovue, USA) devices. The height of edema in the fovea averaged 304.5 ± 5.4 um in the group, in the area of edema outside the fovea — 336.5 ± 7.5 um. The initial best corrected visual acuity (BCVA) was 0.75 ± 0.06. The central retinal sensitivity (CRS) before treatment was 24.10 ± 0.48 dB. The treatment was carried out on the NAVILAS 577S navigation laser system (“OD-OS”, Germany). The results were evaluated within 1, 3 and 6 months after treatment.Results. 1 month after laser treatment, the average CRT in the group was: in the fovea — 294.00 ± 5.38 um, outside the fovea — 318.50 ± 6.44 um. The BCVA increased on average to 0.80 ± 0.06; the CRS to 24.65 ± 0.47 dB. After 3 months, a further decrease in the height of edema was observed (CRT in the fovea was 252.50 ± 2.19 microns, outside the fovea 280.50 ± 3.75 microns). The BCVA increased on average in the group to 0.85 ± 0.06, CRS — 25.50 ± 0.30 dB. After 6 months, the average CRT in the group was: in the fovea — 246.50 ± 1.81 microns, outside the fovea — 273.50 ± 4.56 microns. A stable increase in the BCVA indicators was achieved — 0.85 ± 0.06 and CRS — 26.65 ± 0.16 dB. At the time of 1.3 and 6 months after treatment, an increase in vascular density was observed in the deep vascular complex and the superficial vascular plexus.Conclusion. The preliminary results obtained by us indicate the effectiveness of navigation sub-threshold laser treatment of DME in the micro-pulse and continuous modes, based on targeted topographicallyoriented laser exposure according to OCT angiography.

Диабетик Макула Шишини Даволашда Бўсаға Ости Микроимпульс Лазерли Таъсирлашнинг Ривожланиш Жиҳатлари (Адабиётлар Тахлили)

“…БОМИЛТ макула шиш сўрилиб кетиши (резорбцияси)га имкон беради, кўриш аъзосининг функцияларини барқарорлаштиради ва яхшилайди [2]. БОМИЛТ зарарсиз бўлиб [20,28,31], энг муҳими, ДМШ ни даволашда БОМИЛТ муолажасини кўп марта ўтказиш мумкин [30]. БОМИЛТ нинг селектив таъсири тўр парда пигмет эпителийсининг сўриб олиш функциясини яхшилашга имкон беради, бу ADVANCED OPTHALMOLOGY Volume 7, Issue 1, 2024…”

“…Бўсаға ости микроимпульс лазернинг ишлаш принципи. Одатда қўланилаётган услуб, биринчи навбатда, шиш ўчоғининг тест тарзида нурлантиришни бажаришни ўз ичига олади, кейин идеал "бўсаға ости" қувватни олиш учун қувват 70% га камайтирилади [6,20,31]. Бу даволашдан кейин ҳар қандай вақт ичида пигментли эпителий чандиқли битишни бартараф этиш ва лазер таъсирлашнинг терапевтик самарасини сақлаш ўртасидаги энг мақбул мувозанат эканлиги ҳақида мулоҳаза бор.…”

Comparing the effectiveness of brolucizumab therapy alone versus that combined with subthreshold micropulse laser exposure in the treatment of diabetic macular edema

“…The method of laser treatment employed in the ETDRS has become the technical standard of macular photocoagulation in DME. Conventional laser photocoagulation is effective in eyes with DME, but can result in complications like laser scars, choroidal neovascularization, subretinal fibrosis, retinal pigment epithelial atrophy, visual field narrowing, loss of color vision, metamorphopsia and enlargement of laser scars [1,15,16]. Laser-induced damage to the retina limits the density and repeatability of laser treatment.…”

Subthreshold micropulse laser light in diabetic macular edema (literature review)

“…СМИЛВ позволяет добиться устранения макулярного отека, что стабилизирует и улучшает функцию органа зрения [2]. Метод является наиболее эффективным и безопасным, его можно использовать многократно при лечении ДМО [20,28,30,31]. Селективное воздействие СМИЛВ позволяет улучшить насосную функцию клеток пигментного эпителия сетчатки [9].…”

“…Метод включает выполнение очаговых тестовых излучений, затем мощность снижается до 70 % для получения идеальной субпороговой мощности [6,20,31]. Применение субпорогового диодного микроимпульсного лазера является идеальным для повторного лечения ДМО.…”