RU2629041C1 - Method for laser treatment of diabetic macular edema - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: test coagulates are applied outside the macular edema zone. In the preoperative period, the patient is subjected to optical coherence tomography of the macular area in the "3D references" mode. A map of retinal heights with its vascular pattern is obtained. Using a computer program, coagulation zones on the map are labeled with the same laser radiation power taking into account retina thickness. Laser coagulation is performed, applying coagulants to the edema area, while changing the laser power in accordance with the zones of the obtained map.

EFFECT: increased efficiency and decreased traumatism of laser coagulation of the retina due to selection of the laser coagulation power for various thicknesses of the retina zones in the preoperative period.

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Description

The invention relates to medicine, namely to ophthalmology, and can be used in laser treatment of diabetic macular edema.

A known method of surgery for laser coagulation of the retina in the treatment of diabetic macular edema, when a number of test coagulates are applied intraoperatively on the retina outside the edema region with a gradual increase in laser energy by amplifying the laser radiation power; focusing on the visual picture of the obtained coagulates, they select the optimal test laser power; they begin to impose coagulates on the edema area with test power with a constant visual assessment of their intensity and, if the surgeon regards the next coagulate as insufficient or excessively intense, a power correction is performed to enhance or weaken the intensity of the next coagulate [1].

The disadvantage of this method is the need for intraoperative selection of the optimal laser power in the area of edema, since the intensity of the coagulates is affected, in addition to the laser radiation energy, also by the thickness of the retina, and lasercoagulation is performed in the area of the edema under conditions of different thicknesses of the retina with a constant selection of power as inappropriate intensity of coagulates. This leads to the appearance of low intensity coagulates in areas of edema with a greater thickness of the retina, which reduces the effectiveness of treatment, and coagulates with excessive intensity in areas of edema with a smaller thickness of the retina, which increases the invasiveness of the method [2]. This method is accepted by us as a prototype.

The aim of the invention is to increase the efficiency and reduce the morbidity of laser coagulation of the retina in the treatment of diabetic macular edema.

This goal is achieved by the fact that in the preoperative period the patient undergoes optical coherence tomography of the macular region in the 3D reference mode, and a retinal height map with its vascular pattern is obtained; using a computer program on the map, coagulation zones are marked with the same laser radiation power, taking into account the thickness of the retina; they perform laser coagulation by applying coagulates to the edema region, while changing the laser power in accordance with the zones of the received map.

The advantage of the proposed method is the selection of power during laser coagulation of different thickness of the retina zones of macular edema in the preoperative period. This greatly facilitates and accelerates the implementation of laser coagulation by the surgeon, since it eliminates the need for intraoperative selection of power in the area of edema. As a result, the same planned intensity of all laser coagulates is ensured and coagulates of excessive intensity are prevented, which reduces the invasiveness of the method, or coagulates of insufficient intensity, which helps to avoid repeated operations and increases the efficiency of patient treatment.

The method is as follows. In the preoperative period, the patient undergoes optical coherence tomography of the macular region in the 3D reference mode), and a retinal height map with its vascular pattern is obtained. Using a computer program on the map, coagulation zones are marked with the same laser radiation power, taking into account the thickness of the retina. They perform laser coagulation of the retina: first, test coagulates are applied outside the edema zone, then coagulates are applied to the edema region, while the laser power is changed in accordance with the zones of the obtained map.

The method is illustrated by a clinical example. Patient S., 58 years old, turned to the ophthalmoendocrinological department of SOKOB named after T.I. Broshevsky. Based on complaints, medical history and objective examination, they were diagnosed with non-proliferative diabetic retinopathy in both eyes, focal clinically significant diabetic macular edema of the right eye. A decision was made to conduct laser coagulation of the right eye according to the developed method. In the preoperative period, the patient underwent optical coherence tomography of the macular region in the 3D reference mode and received a map of the heights of the retina with its vascular pattern. Using a computer program on the map, coagulation zones were marked with the same laser radiation power, taking into account the thickness of the retina, of which there were three. They performed laser coagulation of the retina, first they placed test coagulates outside the edema zone with a power of 160 mW. The remaining coagulates were applied to the edema area, increasing the power to 180 mW in the first zone, to 200 mW in the second zone and to 220 mW in the third. These power values for the retinal zones were selected based on the map obtained. There were no intraoperative complications. Immediately after treatment, in control images of the fundus over the entire area of the edema, the coagulates had the same planned intensity. In the postoperative period, complications were not observed in the patient. According to the data of optical coherence tomography in dynamics after two weeks, a decrease in edema by 110 μm was detected. The patient noted an increase in clarity of vision.

A laser treatment method for diabetic macular edema is recommended for use in ophthalmologic hospitals for preoperative selection of the optimal retinal laser coagulation power.

Information sources

1. Early Treatment Diabetic Retinopathy Study Research Group. Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema. ETDRS report No. 2 // Ophthalmology. - 1987. - Vol. 94. - P. 761-774.

2. Zamytsky E.A. Laser treatment of diabetic macular edema // Postgraduate Bulletin of the Volga Region. - Samara, 2015 - No. 1-2 - S. 79.

Claims (1)

A method for laser treatment of diabetic macular edema, including the application of test coagulates outside the edema zone and laser power correction, characterized in that in the preoperative period the patient undergoes optical coherence tomography of the macular region in the 3D reference mode, and a retinal height map with its vascular pattern is obtained; using a computer program on the map, coagulation zones are marked with the same laser radiation power, taking into account the thickness of the retina; they perform laser coagulation by applying coagulates to the edema region, while changing the laser power in accordance with the zones of the received map.