FIELD: medicine.
SUBSTANCE: invention refers to medicine, namely to ophthalmology, and can be used for treating proliferative diabetic retinopathy complicated by epiretinal gliosis. For this purpose, at the diagnostic stage, a fundus image is obtained in conditions of drug-induced mydriasis after two-time installation of 0.8 % tropicamide in combination with 5 % phenylephrine. Further, the patient undergoes OCT in the Retina Map mode and the central retinal thickness (CRT) is assessed, the OCT-A is performed in the En Face mode and the presence of newly formed vessels is determined. If the CRT is more than 450 mcm, the anti-angiogenic preparations are administered intravitreal in three loading doses with interval of 1 month. If the CRT is less than 450 mcm, the antiangiogenic preparation is administered once. One month after the antiangiogenic therapy, panretinal laser coagulation (PLC) is performed. In case of opacity of optical media, a semi-automated pattern PLC is performed on a PASCAL laser, during which a contact corneal panfundus lens is used. Further, the PLC is performed sequentially in two sessions with interval of 5–7 days. During the first session, the coagulates are applied at distance of 1–1.5 diameters from each other within the boundaries of the main vessels to the middle periphery so as to completely cover the intact area of the retina with a laser spot diameter of 100–200 mcm, exposure of 0.05–0.1 s, power of 150–350 mW, wavelength of 532 nm. After 5–7 days, during the second session, the PLC is performed, completely covering the intact retinal area within the boundaries of the previously applied laser coagulates to the extreme periphery, the coagulates are applied at distance of 1–1.5 diameters from each other with the following parameters: laser spot diameter is 300–500 mcm, exposure is 0.05 s, power is 150–300 mW, wave length is 532 nm. In the case of optical media transparency, an automated patterning PLC is performed on NAVILAS 577s navigation laser installation (NLI) with 60 mm Navilas Contact lens. 0.4 % oxybuprocaine is instilled. SuperQuad 160 corneal contact lens is placed on the eye. Then, a colour photograph of the eye ground is taken on the NLI. Further, the retinal navigation PLC is performed sequentially in two sessions with interval of 5–7 days. During the first session, a pattern is selected in the NLI software; the applicates are applied on a color photograph of the eye ground at distance of 0.5–1 diameters from each other so as to completely cover the intact retinal zone from the great vessels to the middle periphery. Then, PLC is performed with laser radiation spot diameter of 300–400 mcm, exposure time of 0.05–0.1 s, power of 150–360 mW, wavelength of 577 nm. In the second session, within the boundaries from the previously applied laser coagulates to the extreme periphery, a pattern is selected in the NLI software, the applicates are applied on a colour photograph of the eye ground, placing them at distance of 0.5–1 diameter from each other, so as to completely cover the intact retinal area, then PLC is performed using laser radiation spot diameter 300–400 mcm, exposure 0.05–0.1 s, power 150–500 mW, wave length 577 nm. Then, 1 month after PLC, the patient undergoes OCT in Line mode and partial dissection of epiretinal gliosis in the zone of maximum tension is performed on the YAG-laser system in Line mode. 0.4 % oxybuprocaine is instilled into the conjunctival cavity. Goldman corneal contact lens is placed on the eye. Zone of epiretinal gliosis in the tension zone of the traction component is exposed to laser radiation, starting from energy of 2 mJ, with its increase until reaching a pulse, which is accompanied by the appearance of vapor-gas bubbles in the vitreous body and fragmentation of epiretinal gliosis, with wavelength - 1064 nm, pulse duration - 4 ns, spot diameter - 8 mcm, laser exposure energy is 2–8 mJ, 30–40 pulses are performed per session, partial YAG-laser dissection is performed in two stages every 7 days.
EFFECT: invention provides a reduction in the tension and divergence of the edges of epiretinal gliosis, which leads to a decrease in the traction component, stabilization of the course of the disease, destruction of ischemic zones, desolation of the newly formed retinal vessels, reduced central thickness of retina, which is accompanied by increased maximally corrected visual acuity, reduced risk of complications of diabetic retinopathy, such as hemophthalmos, tractional retinal detachment.
3 cl, 4 ex
