Retinal Laser Coagulation Research Articles

DYNAMICS OF MORPHOFUNCTIONAL PARAMETERS OF RESISTANT DIABETIC MACULAR EDEMA AFTER SURGICAL TREATMENT

Anti-angiogenic injections are currently established as the «gold standard» for treating diabetic macular edema (DME). Vitreoretinal surgery is indicated in cases involving an epiretinal membrane or vitreoretinal traction syndrome. Some physicians consider it feasible to perform vitrectomy with the removal of the internal limiting membrane in patients with this condition.The objective of this study is to assess changes in the morphofunctional parameters of the retina in patients with resistant forms of DME who have undergone surgical intervention. At the N.I. Pirogov National Medical and Surgical Center, 75 patients diagnosed with DME unresponsive to conservative therapy (anti-vascular proliferation therapy, retinal laser coagulation) were operated on. All patients were divided into three groups based on the type of intervention.Evaluation of best-corrected visual acuity after surgery revealed a statistically significant improvement in this parameter among patients in the second and third groups compared to those in the first group six months post-operation. Patients in the third group showed a notable reduction in retinal thickness in the foveal area one month after the intervention. A significant decrease in edema was observed in patients from the second and third groups compared to those in the first group over the period from one month to one year. When assessing light sensitivity, a significant improvement in parameters was noted in patients from the second and third groups compared to the data from the first group one week after the surgery.The results confirm the high effectiveness of vitreoretinal surgical intervention in patients with resistant diabetic macular edema, affirming the possibility of selecting a surgical approach.

Морфофункциональные параметры диабетического макулярного отека после витреоретинальной хирургии

Background. Diabetic macular edema (DME) is a socially significant disease of our time. At the moment, intravitreal administration of antivasoproliferative drugs is the “gold standard” for the treatment of DME. Currently, indication for vitrectomy and membrane peeling for macular edema is the presence of an epiretinal membrane or vitreoretinal traction syndrome. Some authors consider use of vitrectomy with internal limiting membrane peeling to be justified in patients with DME. Purpose. To evaluate changes in the morphofunctional parameters of the retina in patients after vitreoretinal intervention for resistant diabetic macular edema. Methods. 44 patients diagnosed with DME with no response to previous conservative treatment (laser coagulation, angiogenesis inhibitors) underwent surgery at the ophthalmology center of the National Medical Research Center named after N. I. Pirogov. Results When analyzing BCVA after vitreoretinal surgery, a significant increase in functional parameters was revealed in patients of group 2 (vitrectomy) compared with similar parameters in patients of group 1 (continuing treatment) within 6 months from the date of surgery (p = 0.027). There is also a statistically significant decrease in retinal thickness in patients of group 2 compared with patients of group 1 within 1 month (p = 0.035). When assessing photosensitivity, there was a significant increase in parameters in patients of group 2 compared with preoperative parameters and with similar parameters in patients of group 1 within 1 week from the moment of surgery (p = 0.023). Conclusion. It was found that vitreoretinal surgery with membrane peeling provides a higher functional result compared to the group where only angiogenesis inhibitors and retinal laser coagulation were used from 6 to 12 months of observation. By the 1st week of observation, in patients of group 2, in comparison with the results of patients in group 1, there was a more pronounced positive dynamics of photosensitivity which persisted for 12 months. More pronounced edema resorption was also observed in the group in which vitrectomy with internal limiting membrane peeling was used. Thus, these data confirm that use of vitreoretinal surgery is possible in the treatment of diabetic macular edema. Further study of this issue is required. This study was conducted on a small sample of patients. To confirm the statistical reliability of the results, it is necessary to study the data when examining a larger sample in groups. Key words: DME; diabetic macular edema; vitrectomy; membrane peeling.

Эволюция транспупиллярной лазерной коагуляции сетчатки в лечении активной ретинопатии недоношенных: от режима одиночного импульса до навигационного сопровождения

Abstract Evolution of transpupillary laser coagulation of the retina in the treatment of active retinopathy of prematurity: from single pulse mode to navigational support A.V. Tereshchenko, I.G. Trifanenkova, Yu.A. Sidorova, V.V. Firsova, V.V. Shaulov S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga branch, Kaluga, Russian Federation K.E. Tsiolkovski Kaluga State University, Kaluga, Russian Federation Purpose. To present the development stages and results of 18 years of experience in laser technologies application for the treatment of premature infants with active ROP in the Kaluga branch of S. Fyodorov Eye Microsurgery Federal State Institution. Material and methods. Transpupillary laser coagulation of the retina (LCR) was performed in 1583 children (2537 eyes) with active ROP for the period from 2004 to 2021. LCR was carried out with various stationary laser ophthalmocoagulators. Stages 2 and 3 of active ROP with an unfavorable disease course, stage of early clinical manifestations, manifestation of aggressive posterior ROP were indications for laser treatment. Results. Transpupillary LCR began to be performed for children with active ROP with a stationary ophthalmic coagulator for the first time in Kaluga branch of the S. Fyodorov Eye Microsurgery in 2004. The technology of patterned LCR in active ROP was applied for the first time at domestic and international clinical practice, in the Kaluga branch of Eye Microsurgery in 2009. Pattern LCR began to be performed on the Integre Pro Scan device in 2016. Pattern with the most dense and uniform arrangement of laser applications – hexagonal – was identified. In 2021 transpupillary LCR of the avascular zone of the retina was performed in automatic mode with navigation support on the Navilas 577s laser system. It was possible to perform LCR of the avascular zone of the retina up to the dentate line in all cases. Regression of disease was achieved in 100% of cases. Conclusion. Evolution of laser technologies and the experience of their use demonstrate the high efficacy, safety and predictability of the results of laser treatment of active ROP. Modern pattern laser techniques are highly effective, safe, dosed and tissue-saving, which can serve as the basis for standardization of retinal laser coagulation technology in the treatment of active ROP. Key words: retinopathy of prematurity, unfavorable type of course, laser coagulation of the retina, hexagonal pattern, navigation system

Development of the refraction and axial length of the eye in preterm infants with retinopathy of prematurity after retinal laser coagulation depending on the age

Development of the refraction and axial length of the eye in preterm infants with retinopathy of prematurity after retinal laser coagulation depending on the age

Results of treatment of optic disc pit maculopathy in children

Purpose: to analyze the anatomical and functional results of the differentiated treatment of optic disc pit maculopathy in children.Material and methods. We examined 23 children aged 5–17 years with an o ptic disc pit maculopathy. 10 children underwent retinal laser coagulation (LC) along the borders of the optic disc pit (1–3 sessions), 13 children underwent pars plana vitrectomy with gas tamponade (C2F6) in combination with retinal LC. In addition to the standard ophthalmological examination, all children underwent optical coherence tomography of the macular area of the retina before treatment and at different times after it.Results. In the group of children who underwent LC, the initial value of the maximum retina elevation averaged 525 ± 140 μm (from 346 to 882 μm). After laser treatment, all children showed a decrease in retinal elevation by 32 to 602 μm. 3 children had complete resorption of subretinal fluid during follow-up periods from 5 to 13 months. Best corrected visual acuity (BCVA) remained stable in 5 children, increased by 0.04–0.6 in 4 children, and decreased by 0.1 in one child. In the group of surgically treated children, the elevation of the retina before the intervention averaged 919 ± 143 μm (from 614 to 1420 μm) (p < 0.05). After the intervention, this parameter decreased in all children by 91 to 811 μm, complete resorption of subretinal fluid was observed in 4 children during follow-up periods from 4 to 6 months. BCVA remained stable in 5 children, increased in 7 children by 0.1–0.7, and decreased by 0.4 in one child due to the progression of the cataract.Conclusion. The differentiated approach to the treatment of optic disc pit maculopathy in children proved to be highly efficient, depending on the height of retinal elevation in the macular zone before the start of treatment.

Отдельные аспекты применения ингибиторов VEGF в лечении ретинопатии недоношенных

Nowadays increasing use of VEGF (vascular endothelial growth factor) inhibitors in the ROP (retinopathy of prematurity) treatment, undergoing clinical trials in Russian Federation, as well as the widely VEGF inhibitors off-label using, make this review higly relevant. In this work it was possible to reflect some significant aspects of the VEGF inhibitors application in the ROP treatment, which the researchers focus on. Evaluating the effectiveness of VEGF inhibitors in the treatment of ROP in zone II (stage 3+), bevacizumab therapy and retinal laser coagulation proved to be effective. The use of 0.2 mg of ranibizumab is more effective compared to laser treatment in patients with ROP stage 3+. Analysis of the treatment effectiveness of ROP in zone I (stages 1+, 2+, 3+) showed that ranibizumab is more effective than retinal laser coagulation (68% and 61%, respectively), however, without statistically significant differences. Results of surgical treatment of ROP indicate its high efficiency at stage 4a. There are limited data, according to the results, the combination of vitrectomy with the introduction of VEGF inhibitors leads to a faster regression of the disease. Data on the systemic effects of VEGF inhibitors available in the literature are contradictory, which requires further study of this problem. Key words: retinopathy of prematurity, VEGF inhibitors, literature review

The efficiency of laser treatment of familial exudative vitreoretinopathy in children

Familial exudative vitreoretinopathy (FEVR) is a hereditary disease characterized by abnormal angiogenesis and avascular zones (AZ) on the retinal periphery. The leading method of treatment of its early stages (1–3) is laser coagulation (LC) of AZ and pathological retinal vessels.Purpose. To study the efficiency of retinal laser coagulation in children with various stages of FEVR.Material and methods. 65 children with FEVR (82 eyes) were observed after retinal LC for 6 months to 10 years (on average, 3 years). The efficiency of laser treatment was evaluated after 2–3 months. We regarded the result as stabilization if no progression of the disease could be observed over the entire follow-up period (at least 12 months), either with or without an additional LC.Results. The efficiency of a single LC in children with FEVR in stage 1 was 100 %, in stage 2, 50 to 56 %, in stage 3, 10 to 50 %, in stage 4, 20 to 33 %. The proportion of cases with long-term (over 12 months) stabilization after additional LC sessions was diminishing according to the initial severity of clinical manifestations: from 75–100 % in stages 1–2 to 41–60 % in stage 3 and to 17–20 % in stage 4.Conclusion. LC efficiency of AZ and pathological retinal vessels in children with FEVR is inversely proportional to the stage of the disease. In more than half of the cases, repeated sessions of LC are required to achieve stabilization. The persistence of vascular activity after LC or the appearance of new vascular malformations are prognostic signs of further FEVR progression. The results obtained indicate the need for an early detection of the disease and an LC procedure to prevent the development of extensive retinal detachment, as well as regular dynamic observation of the patients and further study of the pathogenetic mechanisms of FEVR progression.

Оценка макулярного кровотока с помощью оптической когерентной томографии-ангиографии у беременных женщин, страдающих сахарным диабетом

Purpose. To study retinal blood flow in pregnant women with disorders of carbohydrate metabolism using optical coherence tomography angiography (OCTA) in order to determine the criteria for the manifestation and progression of diabetic retinopathy (DR). Material and methods. 203 pregnant women in the third trimester were examined: 24 – with type 1 and 2 diabetes (T1D and T2D), 143 – with gestational diabetes (GD), and 36 apparently healthy women with physiological pregnancy, who consisted the control group. OCTA imaging was performed using the RTVue XR Avanti OCT 6 mm × 6 mm «Angio Retina» scan protocols (Optovue, USA). The whole image vessel density (wiVD), foveal vessel density (FVD), and foveal avascular zone (FAZ) area in the superficial capillary plexus were studied. Results. FVD in pregnant women with diabetes was significantly less than in pregnant women with GD and in the control group. In this connection, it can be assume changes of the retinal microvascular regulation, due to chronic disorders of carbohydrate metabolism in patients with diabetes, and development of microangiopathy. Enlargement of FAZ area and decrease of wiVD were revealed in patients with DR, relative to datas obtained in the group of pregnant women with diabetes and absence of DR, in the absence of differences in FVD indexes. In 2 patients with T1D and the absence of ophthalmoscopic signs of DR, OCTA revealed areas of nonperfusion in the posterior pole of the eye. Conclusion. OCTA helps to identify areas of retinal nonperfusion in the posterior pole of the eye in pregnant women with diabetes in the absence of ophthalmoscopic signs of DR and allows determining objective indications for timely retinal laser coagulation. Keywords: optical coherence tomography angiography, pregnancy, diabetic retinopathy, gestational diabetes, foveal avascular zone, retinal blood flow

Анализ эффективности экстракции прозрачного хрусталика (ЭПХ) с имплантацией искусственного хрусталика при коррекции миопии высокой степени

The purpose of this work was to study the effectiveness of extraction of a transparent lens in order to correct myopia of medium and high degree. Currently, the correction of high-grade myopia is carried out with the use of phakic intraocular lenses (FIOL), since the correction of LASIK and PRK is not indicated, with a thinned cornea of myopes at a young age. In this paper, the results of cataract phacoemulsification of 20 patients (40 eyes) with moderate and high myopia, with implantation of hydrophobic acrylic IOLS Acrysof (Alcon, USA) in the middle age category (46.6±6.3) were analyzed. with high-grade myopia (M from -7.0D to -19.0D), 14 of them were women and 6 were men. Moderate myopia was detected in 6 patients (12 eyes) and high degree in 14 patients (28 eyes). In the preoperative period, 15 patients (30 eyes) underwent peripheral retinal laser coagulation (30 eyes). Operations were performed on two eyes with an interval of 2-3 weeks, depending on the state of the organ of vision and the general condition of patients. High visual acuity was obtained from 0.6 to 1.0 without correction and averaged =0.83 ±0.05. The accommodative capabilities of the artificial eyes were stopped by the appointment of weak positive lenses. Keywords: phacoemulsification, high degree myopia, IOL implantation, accommodation

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

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.

Клинические случаи тяжелого течения послеоперационного периода у детей с увеальными осложнениями лазеркоагуляции при ретинопатия недоношенных

The most likely complications of laser coagulation in the active stages of retinopathy of prematurityis the occurrence of a pronounced inflammatory process, which may requre surgical treatment. In most cases, a positive effect occurs after a single surgical intervention. Purpose. Analysis of three clinical cases of severe postoperative course in children with uveal complications of laser coagulation in retinopathy of prematurity. Discussion. In these cases, the severe course of the postoperative period was noted in somatically severe children, including those with severe bronchopulmonary dysplasia, with infectious diseases of various etiologies suffered in intrauterine and the early period of development, including after surgery. Conclusion. Children who have had uveitis after laser coagulation of the retina are subject to careful dynamic observation. It is necessary to conduct unscheduled examinations after infectious diseases. Keywords: retinopathy of prematurity, laser coagulation of retina, uveal complications, cataract

Навигационная лазерная коагуляция сетчатки при активной ретинопатии недоношенных: новый взгляд на старую проблему

Purpose.To demonstrate the possibilities and determine the specific features of navigational transpupillary laser coagulation of the retina in children with active stages of retinopathy of prematurity. Material and methods. Navigational transpupillary laser coagulation of the retinal avascular zones (LC) was performed in 9 premature infants in the active ROP with an unfavorable type in 18 eyes, of which 2nd stage of the disease was diagnosed in 10 eyes, 3rd stage with epiretinal neovascularization in the projection of the extraretinal proliferation ridge – in 8 eyes. Laser treatment in all cases was carried out transpupillary on the NAVILAS 577s laser system (OD-OS, Germany) using a pediatric corneal contact panfundus lens. Results. In result of the navigation LC in children with active ROP stages regression of the disease was achieved in all cases, the required amount of laser coagulation was performed in one session, in the avascular zone of the retina, regardless to the localization of the pathological process, while the implemented treatment plan fully corresponded to preoperative planning. Conclusion. The presence of navigation support for laser interventions allows for effective, safe and dosed treatment for patients with active ROP. Keywords: retinopathy of prematurity, retinal laser coagulation, automated navigation laser system

Междисциплинарный подход в диагностике и лечении макулярного отека, обусловленного тромбозом центральной вены сетчатки или ее ветвей

Purpose. To present clinical cases of macular edema associated with central retinal vein thrombosis (CRVT) of various etiologies. Material and methods. A prospective study of patients with macular edema associated with thrombosis of the central retinal vein or its branches in real clinical practice was conducted. All patients underwent a standard ophthalmological examination, as well as optical coherence tomography (OCT), and a biochemical blood test was performed on a patient with suspected macroglobulinemia. Results. In the first clinical case, macular edema was associated with retinovasculitis. The patient was consulted by a rheumatologist, diagnosed with idiopathic dermatomyositis, polymyositis, confirmed seropositive form. A long-term regimen of glucocorticosteroid drugs (Prednisone), courses of lymphosorption was prescribed. Treatment was carried out for macular edema, occlusion of the central nervous system on the background of retinovasculitis: anti-VEGF therapy, retinal laser coagulation. In the second clinical case, macular edema on the background of CRV thrombosis associated with Waldenstrom's disease. It is recommended to monitor and treat the underlying disease with a hematologist. Conclusion. Thus, macular edema occurring against the background of thrombosis of the central nervous system and its branches, having atypical symptoms in the form of exudative retinal detachment, the presence of a bilateral process, young age and the absence of risk factors for the development of retinal vein occlusion, as well as resistance to anti-VEGF therapy requires careful collection of anamnesis taking into account the patient's somatic condition and the presence of other ophthalmological vascular pathology. Keywords: macular edema, retinovasculitis, Waldenstrom macroglobulinemia

Clinical manifestation, course and treatment results of Coats disease in children

Purpose: to analyze the clinical manifestations, course, and results of treatment of Coats disease in children. Materials and methods. We performed a retrospective analysis of medical records of 59 patients with Coats retinitis (83 % were boys) who had been comprehensively examined and treated between 2018 and 2021. After the diagnosis was verified, the children were hospitalized for treatment. Retinal laser coagulation was performed on 61 eyes, angiogenesis inhibitors were administered on 1 eye, and 5 eyes received microsurgical interventions. Results. At the time of disease detection, the children’s age varied from 1 to 16 years. In 97 % of cases, the process was unilateral. An improvement of the anatomical condition and the eye-preserving effect were achieved in 87 %. Visual acuity could only be increased in 19 eyes (31.1 %), all with the initial or the advanced stages of Coats retinitis. Proceeding from our experience, the analysis of polymorphism of clinical manifestations, functional prognosis and differentiated approach to treatment depending on the prevailing clinical symptoms, we suggest a new variant of clinical classification of Coats retinitis. Conclusion. In order to ensure a timely diagnosis of the disease, a very thorough examination of patients in the first decade of life is required. Only an early diagnosis and timely treatment can help achieve not only an eye-preserving effect but also functional results.

The development of laser technologies in vitreoretinal surgery (publications review)

The article presents review of scientific publications on development of laser treatment methods in vitreoretinal surgery. The use of photo-therapy in medicine dates back to ancient times, when people began to use sunlight as treatment of various diseases. The heyday of photo-therapy falls on the second half of the XIX century, which was associated with the invention of first electric lamps. In 1960, T. Maiman developed the world's first laser, revolutionizing precision and control of light delivery. This was the beginning of heyday of laser surgery primarily in ophthalmology, where potential of lasers was instantly recognized. The subsequent discovery of argon laser in 1964 by W. Bridges (USA) marked new era in retinal photo-coagulation. Then new types of lasers with various systems of delivering laser radiation appeared that significantly expanded range of application of laser technologies in ophthalmology and vitreoretinal surgery. Currently, the lasers are applied in oculoplasty, refractive and corneal surgery, in laser support of phacoemulsification of cataract, in treatment of glaucoma, in laser coagulation of retina and thermotherapy. In vitreoretinal surgery laser technologies remain at the level of the XX century. Thus, they are still applied only for endolaser coagulation of retina. And this despite the fact that there is immense potential for applying lasers as "laser scalpel" to remove vitreous humor, epiretinal fibrosis, retinotomy and choroidotomy.

Development of a Computer System for Automatically Generating a Laser Photocoagulation Plan to Improve the Retinal Coagulation Quality in the Treatment of Diabetic Retinopathy

In this article, the development of a computer system for high-tech medical uses in ophthalmology is proposed. An overview of the main methods and algorithms that formed the basis of the coagulation plan planning system is presented. The system provides the formation of a more effective plan for laser coagulation in comparison with the use of existing coagulation techniques. An analysis of monopulse- and pattern-based laser coagulation techniques in the treatment of diabetic retinopathy has shown that modern treatment methods do not provide the required efficacy of medical laser coagulation procedures, as the laser energy is nonuniformly distributed across the pigment epithelium and may exert an excessive effect on parts of the retina and anatomical elements. The analysis has shown that the efficacy of retinal laser coagulation for the treatment of diabetic retinopathy is determined by the relative position of coagulates and parameters of laser exposure. In the course of the development of the computer system proposed herein, main stages of processing diagnostic data were identified. They are as follows: the allocation of the laser exposure zone, the evaluation of laser pulse parameters that would be safe for the fundus, mapping a coagulation plan in the laser exposure zone, followed by the analysis of the generated plan for predicting the therapeutic effect. In the course of the study, it was found that the developed algorithms for placing coagulates in the area of laser exposure provide a more uniform distribution of laser energy across the pigment epithelium when compared to monopulse- and pattern-based laser coagulation techniques.

Роль блокады ангиогенеза у пациентов с диабетической ретинопатией

Relevance. The proliferative stage of diabetic retinopathy is characterized by angiogenesis, which is largely mediated by the vascular endothelial growth factor. Peripheral retinal laser coagulation has been standard treatment for PDR for many years, providing control of ischemia and reduction of vascular endothelial growth factor levels with subsequent regression of neovascularization. However, it leads to serious functional deficits and anatomical complications. The advent of antivascular endothelial growth factor (anti-VEGF) agents has changed the future of PDR management and has provided an alternative to pan retinal photocoagulation. Their combination with panretinal photocoagulation may be effective for the treatment of proliferative diabetic retinopathy and concurrent diabetic macular edema. Anti-VEGF therapy also takes place in surgery of complicated PDR. Purpose. To analyze the relevance of the use of anti-VEGF drugs in the treatment of the proliferative stage of diabetic retinopathy. Material and methods. The literature review is written using PubMed, Сochrane Library, 29 literature references published up to 2021. Results. In patients with severe cases, preoperative treatment is a gentle approach for the anatomic structures of the eye, it also contributes to the reduction in the number of intraoperative and postoperative complications. Conclusion. Preoperative treatment is a gentle approach for the anatomic structures of the eye, it also contributes to the reduction in the number of intraoperative and postoperative complications. Key words: anti-VEGF, diabetic macular edema, proliferative diabetic retinopathy.

Effectiveness of laser coagulation in children with Coats’ disease

AIM: This study aimed to investigate the effectiveness of retinal laser coagulation in children with Coats disease.
 MATERIAL AND METHODS: The study included 118 patients who were examined and treated from January 2017 to December 2021; 102 of them were boys (86.6%) and 16 were girls (13.4%). All children had unilateral disease. All children underwent a comprehensive ophthalmological examination. Laser coagulation was performed in 113 patients using a green laser (532 nm). The number of retinal laser coagulation sessions ranged from 2 to 13 (on average 5.22.36) with intervals from 1.5 to 6 months (on average 2.010.46).
 RESULTS: Generally, retinal laser coagulation was effective in CD in 85.8% of cases (in 97 of 113 children). Effectiveness was 100% for vascular malformations and exudates outside the macula, 97.3% for vascular and exudative retinal changes involving the macular zone, 92.3% for local retinal detachment, 90.5% for widespread retinal detachment, 60.0% for subtotal retinal detachment, and 30.0% for total. Only those who had peripheral Coats disease symptoms were found to have visual acuity of 0.6 or above, both before and after treatment. Visual acuity did not exceed 0.1 in 92% of patients with vascular and exudative changes in the periphery and in the macula and in 94% with local and widespread retinal detachment. After successful retinal laser coagulation, 11 children (13.4%) had visual acuity of 0.4 or higher, 13 children (15.9%) had visual acuity between 0.1 and 0.3, 45 children (54.9%) had finger count of 0.09, and 13 children (15.9%) lack objective vision.
 CONCLUSION: Retinal laser coagulation using a laser with a wavelength of 532 nm is an effective method for treating CD at all stages, including cases of the disease with the development of retinal detachment.

Treating diabetic macular edema: comparative efficacy of 577 nm laser navigation exposure and threshold 532 nm laser coagulation combined with anti-angiogenic therapy

The Navilas 577 laser system integrates a laser coagulator with a tracking system and a fundus camera. The system ensures operation planning and representing the results of optical coherence tomography on the fundus image, which makes the treatment fast, clearly observable and safe and minimizes damage to healthy tissues.Purpose. To compare the results of threshold laser coagulation in the treatment of DME using a Navilas 577 laser and a Quantel Medical 532 nm device.Materials and methods. 64 patients aged 41–80 (64 eyes) with DME less than 350 μm high were examined after intravitreal administration of angiogenesis inhibitors and threshold lattice laser coagulation using Quantel Medical 532 and Navilas 577.Results. A lower height of the edema and an increase in visual acuity were observed in both cases, but in the Navilas 577 laser group the BCVA was higher than in Quantel Madical 532, whilst the edema height in the Navilas 577 laser group in the central fovea area was less high.Conclusion. 1. The combination of retinal laser coagulation and angiogenesis inhibitors in the treatment of low DME (less than 350 μm) provides good results, so it can be justified and expedient in real clinical practice. The efficiency of 577 nm navigation laser exposure was found to be higher than that of threshold 532 nm laser coagulation.

Application of Artificial Intelligence in Ophthalmology for the Diagnosis and Treatment of Eye Diseases

In this paper, we present the main aspects of artificial intelligence application in ophthalmology for the diagnosis and treatment of eye diseases on the example of developing a computer system for personalizing retinal laser photocoagulation. Approaches to the automation of eye disease prediction and treatment based on fundus images are described. Four problems of applying the neural network approach are highlighted. Decision support information technology for personalizing laser treatment of diabetic macular edema and identifying prognostic factors of surgical outcome using methods of intellectual analysis of large unstructured data is described. The system allows the doctor to form a plan of optimal coagulation arrangement for retinal laser coagulation for each case, to predict the quality of laser coagulation depending on the initial data on the localization and severity of edema and to improve his skills by comparing the result of coagulation performed and the coagulation plan proposed by the system.