FIELD: medicine; ophthalmology.
SUBSTANCE: topographic localization of ischemic zones is determined according to the data of a complex analysis of OCT angiograms of the superficial vascular plexus (SVP) and deep vascular complex (DVC), microaneurysm zones, the localization and extent of edema according to OCT angiograms performed in the En Face mode at the DVC level. Micropulse and continuous laser action is used in a selective range of continuous mode energy parameters: pulse duration is 0.01 s, spot diameter is 100 μm, power is 50–300 mW, wavelength is 577 nm. A pattern of three planned applications is selected in the software of the navigation laser unit (NLU) at a distance of one spot diameter from each other and positioned in such a way as to completely cover the ischemic zones on a color photograph with an overlay OCT angiogram of the PSS, excluding the foveal avascular zone (FAZ). Then the pattern is set at a distance of 0.25 of the diameter of the planned applicate with the above parameters of the continuous mode and the zones of microaneurysms are covered on the same color photograph with the superimposed OCT angiogram of the DVC, excluding FAZ, the following parameters of the micropulse mode are set: the wavelength of the yellow spectrum, the duration of the micropulse is 100 μs, duty cycle is 4.8%, power is 0.4–1.9 W, spot diameter is 100 µm, the number of pulses in a packet is 10; a pattern is selected from three planned applicators, placing them at a distance of 0.25 spot diameter from each other, completely covering the areas of edema and microaneurysms and ischemia, including FAZ when edema spreads to it, excluding ischemia and microaneurysms already covered with previously planned appliques in continuous mode. Before micropulse laser exposure, computer microperimetry is performed according to “macula_12° 10 dB” protocol using software, a color interpolated map of retinal photosensitivity is applied to the same color photograph of the fundus. Before laser exposure, an intact zone is left along the edema zone in the FAZ consisting of a pattern of seven planned applications closely spaced to each other with a spot diameter of 100 μm, forming a hexagonal figure, the center of which corresponds to the fixation point on the interpolated retinal photosensitivity map, preliminary, to determine individual power required for micropulse and continuous operation. Testing is carried out by using three appliques with different parameters to the intact retina in the region of the upper or lower vascular arcade. Then, after testing, in 1 hour, a study of short-wave autofluorescence is carried out with an assessment of visible appliques. 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 power is set in the NLU software and treatment is carried out.
EFFECT: method allows to reduce the area or completely eliminate ischemic zones, reduce leakage from microaneurysms or completely close them, to allow resorption of solid exudates, hemorrhages and edema, as well as to reduce the thickness of the retina and eliminate the cysts development.
1 cl, 3 ex
