METHOD FOR TARGETED TREATMENT OF DIABETIC MACULOPATHY WITH FOCAL DIABETIC MACULAR EDEMA USING NAVILAS 577S LASER

摘要

FIELD: medicine, ophthalmology.;SUBSTANCE: invention relates to medicine, namely to ophthalmology. The localization of edema is determined according to the data of optical coherence tomography and micropulse laser exposure is carried out in the selective range of energy parameters. Laser applications are applied at a distance of one diameter of the application from each other with the following parameters of the micropulse mode: the wavelength of the yellow spectrum, the duration of the micropulse is 50-100 mcs, the duty cycle is 0.5-4.7%, the power is 0.4-1.9 W, the spot diameter is 50-150 microns, the number of pulses in the packet is 1-20; and in the foveal avascular zone - with parameters: yellow spectrum wavelength, micropulse duration 50-80 mcs, duty cycle 0.5-2.5%, power 0.8-2.0 W, spot diameter 80-130 microns, quantity pulses in a package 1-10. A pattern is selected and applicators are applied, placing them at a distance of 0.25 of the spot diameter from each other, completely covering the edema zone, including the foveal avascular zone, when edema spreads to it. Before micropulse laser exposure, the topographic localization of ischemic zones is determined according to the data of a complex analysis of optical coherence tomograms-angiograms of the superficial vascular plexus (SVP) and deep vascular plexus (DVP). Then, the zones of microaneurysms, localization and prevalence of edema are determined according to optical coherent tomograms-angiograms performed in the En Face mode at the level of the DVP. Then two identical color photographs of the fundus are performed on the NLU software, superimpose the optical coherence tomogram-angiogram of the SVP on the first color photograph of the fundus. Then, using the NLU software, the necessary parameters of the continuous mode of laser radiation are set: pulse duration 0.01 s, spot diameter 100 microns, power 50-300 mW, wavelength 577 nm. A pattern is selected in the NLU software and applicators are applied, placing them at a distance of one spot diameter from each other, and positioning them so as to completely cover the ischemic zones in the first color photograph with superimposed optical coherence tomogram-angiogram of the SVP, excluding the foveal avascular zone. Then the pattern is set at a distance of 0.25 of the diameter of the laser applicate with the same parameters of the continuous mode, and the area of microaneurysms is covered in the second color photograph with the imposition of an optical coherence tomogram-angiogram of the DVP, excluding the foveal avascular zone. Then, the above parameters of the micro-pulse mode are set, while additionally affecting the zones of microaneurysms and ischemia located in the foveal avascular zone, excluding the zones of ischemia and microaneurysms already covered with laser applications in a continuous mode. Previously, to determine the individual power required for the micropulse and continuous mode, testing is carried out by applying three applications with different parameters to the intact retina in the area of the upper or lower vascular arcade. Then, after testing, after 1 hour, a shortwave autofluorescence study is carried out with an assessment of visible applications. In this case, for the continuous mode, the minimum power is selected, which causes visible damage to the retinal pigment epithelium, and for the micropulse mode, the minimum power, which causes visible damage to the retinal pigment epithelium, is increased by 0.1 W. Then the selected powers are set in the NLU software and the treatment is carried out.;EFFECT: invention allows eliminating ischemic zones, reducing microaneurysms or closing them, reducing the resorption of solid exudates, hemorrhages and edema, reducing the thickness of the retina, and eliminating cysts.;1 cl, 3 ex