FIELD: medicine; ophthalmology.
SUBSTANCE: patient is preliminarily subjected to optical coherence tomography (OCT) which determines the central retinal thickness (CRT), and if the CRT is 450 μm or less, diagnosis and treatment of diffuse diabetic macular edema (DME) is carried out. The topographic localization of ischemic zones is determined according to the complex analysis of optical coherence tomography-angiography (OCT-A) at the levels of the superficial vascular plexus (SVP) and deep vascular complex (DVC) by switching the Superficial and Deep modes in the OCT software -A. The presence of microaneurysms is determined by OCT angiograms performed in the En Face mode at the DVC level. Next, two identical color photographs of the fundus are taken on the NLI using the software, digital OCT-A images are superimposed and compared with color photographs of the fundus: SVP on the first color photograph of the fundus, then DVC on the second color photograph of the fundus. Then, using the NLI software, the required parameters of laser radiation are set: in the macular zone, excluding the foveal avascular zone (FAZ), the diameter of the laser radiation spot is 50–100 microns, the exposure is 0.05–0.1 s, the power is 50–150 mW, wavelength is 577 nm, outside the laser spot diameter is 100–200 microns, exposure is 0.1–0.2 s, power is 100–350 mW, wavelength is 577 nm, a pattern is selected in the NLI software, the applicators are applied at a distance of 1.5 diameters from each other, in such a way as to completely cover the ischemia zones in the fundus, in accordance with the plan formed on the first color photograph with the overlay of the optical coherence tomogram-angiogram of the SVP, and the area microaneurysms on the second color photograph with an overlay of an optical coherence tomogram-angiogram of DVC. One month after the treatment, OCT-A is performed: when the retina is attached, the patient is transferred to a dispensary observation, and if there are signs of DME, repeated laser coagulation is performed with the above parameters until it is completely attached. If the value of the CRT index is over 450 μm, an intravitreal injection of an angiogenesis inhibitor (anti-VEGF) is performed, which is used as ranibizumab at a dose of 0.5 mg or aflibercept at a dose of 2 mg. One month after the administration of anti-VEGF, OCT is performed: if the CRT value is over 450 µm, the above sequence of actions is repeated until the CRT value reaches 450 µm or less, with a decrease in the CRT in the fovea to 450 µm or less, diagnostics and treatment of DME are performed as above.
EFFECT: method allows to reduce the area of zones or disappearance of ischemic zones, prevent progression of the disease, reduce leakage from microaneurysms or their closure, resorption of edema, reduce the thickness of the retina, maximize corrected visual acuity (MCVA), central retinal photosensitivity and stabilization of visual functions, as well as reduce the amount of the medicinal products administered and angiogenesis inhibitors injections.
1 cl, 3 ex
