Combined Treatment of Post-Thrombotic Macular Edema with Navigation Laser Coagulation and Intravitreal Administration of Angiogenesis Inhibitors

Abstract

At present about 16.4 million people in the world suffer from retinal venous occlusions (RVO). The pathophysiology of RVO includes changes in the vascular wall, blood flow, blood clotting. The key role in the pathogenesis of this group of diseases is played by ischemia and retinal hypoxia, leading to neovascularization. Macular edema (ME) is the most common complication of retinal vein occlusions. Optical coherence tomography-angiography (OCTA) is considered as an informative and highly sensitive method for diagnosing macular edema (ME) and ischemic zones in RVO. Intravitreal administration of glucocorticosteroids and/or angiogenesis inhibitors is the priority treatment method for macular edema in RVO. The combination of antiangiogenic therapy and laser treatment is promising. The navigation treatment technology is implemented under the conditions of the Navilas 577 system. The Navilas 577 laser navigation system is a laser coagulator with a tracking system and a fundus camera. The possibility of planning the operation, superimposing the results of OCTA on a fundus image makes the treatment faster, more accurate, and minimizes damage to healthy tissues.Purpose: to evaluate the results of target topographically oriented threshold laser coagulation in the treatment of post-thrombotic ME using theNavilas 577 laser navigation system following intravitreal administration of angiogenesis inhibitors.Materials and methods. There was performed a prospective study of the results of navigation laser treatment on the Navilas 577 device after intravitreal injections of angiogenesis inhibitors in 14 patients (14 eyes), aged 51 to 83 years, with macular edema up to 390 μm due to the branch central retinal vein occlusion. Laser treatment was performed within 2 weeks to 1 month following the last injection of angiogenesis inhibitors. The zones of ischemia in the macula were determined according to OCT-A data, imported into the Navilas 577 navigation system and superimposed on a color fundus image. Then the treatment was planned — the position of the future coagulates was marked.Results. In 3 months, there was a decrease in the height of edema from 366.5 (323;390) to 280 (270;300) μm, an increase in light sensitivity in the central retinal zone from 17 to 21.2 dB and an increase in visual acuity from 0.4 (0.3;0.5) to 0.5 (0.45;0.6).Conclusion. The combination of navigation retinal laser coagulation and angiogenesis inhibitors in the treatment of low post-thrombotic edema (less than 390 μm) gives good results; therefore, it can be justified and advisable in real clinical practice.