FLUORESCEINT ANGIOGRAPHY IN THE EVALUATION OF THE RESULTS OF LASER COAGULATION OF THE RETINA AT THE ACTIVE STAGES OF RETINOPATHY OF PREMATURITY

Abstract

The aim of the study is to evaluate the effectiveness of retinal laser photocoagulation (RLC) in retinopathy of prematurity (RP) using fluorescent angiography (FAG), to identify angiographic signs of regression and progression of the disease, the features of the formation of vessels in the previously avascular retina, depending on the RP stage and the method of treatment used. Material and methods. The study included 58 preterm infants (116 eyes) with different stages of active ROP, requiring RLC. Gestational age of children ranged from 24 to 31 weeks (average 28.1 weeks), birth weight – from 680 to 1800 g (average 1100 g). All infants underwent digital retinoscopy with FAG on a retinal pediatric digital video system «RetCam-3» («Clarity Medical Systems Inc.», USA) with a built-in angiographic unit. In 94 cases, LC was performed in the pattern mode on the laser ophthalmic system «PASCAL Photocoagulator» («OptiMedica», USA) using the developed technology of early dosed coagulation optimized for energy parameters. In 12 cases, LC was performed in a single pulse mode on a laser ophthalmic device «Visulas 532s», laser type Nd:YLF («Carl Zeiss Meditec AG», Germany). In 10 cases, the RLC was conducted in the perinatal centre of the extremely premature children nontransportable diode laser «Iridex IQ 810» («IRIDEX», USA) using head ophthalmoscope. Results. The technique of dosed pattern RLC was the most optimal from the point of view of efficiency and safety for a premature baby, which was confirmed by the angiographic data obtained, indicating an active vascular germination in the coagulation zone. Angiographic picture of the regression of RP after the RLC in single pulse was not significantly different from the pattern LC. However, taking into consideration the pattern technology advantages, the single pulse technology should be used only in case of high-tech equipment absence. Postoperative angiographic monitoring after LC using a forehead ophthalmoscope showed the imperfection of this technology, which is manifested by characteristic angiographic signs, such as chaotic growth of blood vessels in the LC area. Conclusion. FAG opens wide possibilities both in the early assessment of the efficacy of LC and in the detailed assessment of the long-term results of treatment depending on the RP stage and the used LC method. The use of the results of FAG studies will contribute to the improvement of laser technologies and improve the quality of RP treatment.