ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2022-3-506-514ophthalmology-1914Research ArticleОФТАЛЬМОХИРУРГИЯOPHTHALMOSURGERYПрименение микроимпульсного и непрерывного лазерного излучения при навигационном топографически ориентированном лечении фокального диабетического макулярного отекаApplication of Micro-Pulse and Continuous Laser Radiation in Navigation Topographically-Oriented Treatment of Focal Diabetic Macular Edema BasedВолодинП. Л.VolodinP. L.

доктор медицинских наук, заведующий отделом лазерной хирургии сетчатки,

Бескудниковский бульвар, 59а, Москва, 127486

МD, head of the Laser retinal surgery department,

Beskudnikovsky blvd, 59A, Moscow, 127486

ИвановаЕ. В.IvanovaE. V.

кандидат медицинских наук, врач-офтальмолог отдела лазерной хирургии сетчатки,

Бескудниковский бульвар, 59а, Москва, 127486

PhD, ophthalmologist of the Laser retinal surgery department,

Beskudnikovsky blvd, 59A, Moscow, 127486

ПоляковаЕ. Ю.PolyakovaE. Yu.

аспирант отдела лазерной хирургии сетчатки,

Бескудниковский бульвар, 59а, Москва, 127486

postgraduate student of the Laser retinal surgery department,

Beskudnikovsky blvd, 59A, Moscow, 127486

ekaterinapolyakova17@yandex.ruФоминА. В.FominA. V.

директор по клиническим испытаниям,

ул. Марксистская, 3, стр. 1, Москва, 109147

director of Clinical Trials,

Marksistskaya str., 3/1, Moscow, 109147

БаталовА. И.BatalovA. I.

ординатор,

Бескудниковский бульвар, 59а, Москва, 127486

resident,

Beskudnikovsky blvd, 59A, Moscow, 127486

ФГАУ НМИЦ «МНТК “Микрохирургия глаза” им. академика С.Н. Федорова» Министерства здравоохранения Российской ФедерацииРоссияS.N. Fyodorov Eye Microsurgery Federal State InstitutionRussian FederationАО «Трейдомед Инвест»РоссияTradomed InvestRussian Federation202205102022193506514Copyright © Володин П.Л., Иванова Е.В., Полякова Е.Ю., Фомин А.В., Баталов А.И., 20222022Володин П.Л., Иванова Е.В., Полякова Е.Ю., Фомин А.В., Баталов А.И.Volodin P.L., Ivanova E.V., Polyakova E.Y., Fomin A.V., Batalov A.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ophthalmojournal.com/opht/article/view/1914

Цель — проанализировать клиническую эффективность субпорогового лазерного лечения фокального диабетического макулярного отека (ДМО) в непрерывном и микроимпульсном режиме с использованием навигационной системы на основе данных оптической когерентной томографии-ангиографии (ОКТ-А).

Пациенты и методы

Пациенты и методы. Под наблюдением находились 33 пациента (33 глаза) с фокальным ДМО до и после лазерного лечения. Всем пациентам выполняли ОКТ-А высокого разрешения по протоколу HD Angio Retina 6×6 мм на приборах RTVue-100 XR Avanti (Optovue, США) и SOLIX (Optovue, США). Высота отека в фовеа составила в среднем по группе 304,5 ± 5,4 мкм, в зоне отека за пределами фовеа — в среднем 336,5 ± 7,5 мкм, исходная максимально корригированная острота зрения (МКОЗ) — 0,75 ± 0,06. Центральная светочувствительность (СЧ) до лечения составила 24,10 ± 0,48 дБ. Лечение осуществлялось с помощью навигационной лазерной системы NAVILAS 577S (OD-OS, Германия). Результаты оценивали в сроки 1, 3 и 6 месяцев после лечения.

Результаты

Результаты. Через 1 месяц после лазерного лечения центральная толщина сетчатки (ЦТС) в среднем по группе составила: в фовеа — 294,00 ± 5,38 мкм, за пределами фовеа — 318,50 ± 6,44 мкм. МКОЗ повысилась в среднем до 0,80 ± 0,06; СЧ центральной зоны — до 24,65 ± 0,47 дБ. Через 3 месяца наблюдалось дальнейшее снижение высоты отека (ЦТС в фовеа составила 252,50 ± 2,19 мкм, за пределами фовеа — 280,50 ± 3,75 мкм). МКОЗ повысилась в среднем по группе до 0,85 ± 0,06, СЧ центральной зоны — 25,50 ± 0,30 дБ. Через 6 месяцев ЦТС в среднем по группе составила: в фовеа — 246,50 ± 1,81 мкм, за пределами фовеа — 273,50 ± 4,56 мкм. Достигнуто стабильное повышение показателей МКОЗ — 0,85 ± 0,06 и СЧ центральной зоны — 26,65 ± 0,16 дБ. В сроки 1, 3 и 6 месяцев после лечения наблюдалось увеличение сосудистой плотности в глубоком сосудистом комплексе (ГСК) и поверхностном сосудистом сплетении (ПСС).

Заключение

Заключение. Полученные предварительные результаты свидетельствуют об эффективности навигационного субпорогового лазерного лечения ДМО в микроимпульсном и непрерывном режиме, основанного на прицельном топографически ориентированном воздействии по данным ОКТ-ангиографии. 

Purpose

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

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

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

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. 

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The authors declare that there are no conflicts of interest present.