FIELD: medical science.
SUBSTANCE: invention relates to medicine, specifically to ophthalmology. It involves laser coagulation of microaneurysms outside the fovea at wave length 577 nm preceded by fluorescent angiography (FAG) and optical coherence tomography (OCT-A). According to the OCT data, the central retinal thickness (CRT) is determined, the OCT-A is used to visualize and topographically localize microaneurysms, for which performing the En Face segmentation at the level of the inner nuclear layer IPL–IPL+20 mcm and IPL–IPL+60 mcm, for visualization of microaneurysms on FAG, an image is used in the arteriovenous and venous phase, method involves the intravitreal introduction of angiogenesis inhibitors (IVIAI) that is ranibizumab 0.5 mg. In 4 weeks after the IVIAI, the OCT is performed to determine the CRT, and the IVIAI is carried out every 4 weeks until the CRT decreases to less than 400 mcm. That is followed by a navigation topographically oriented laser coagulation of microaneurysms on a navigation laser system (NLS) Navilas 577s at wave length 577 nm; a colour fundus photograph is taken on the NLS. Then OCT-A digital image and FAG digital image are superimposed and compared with eye ground picture by vascular pattern using built-in software. Further, on the combined image, each detected microaneurysm is covered, excluding the fovea zone, with a single spot with diameter of 100 mcm, upon achieving drug-induced mydriasis, contactless targeted application of laser coagulates on the eye ground is carried out in an automatic mode in accordance with a predetermined plan with parameters: exposure 0.05 s, power 50 mW in parafovea and 100 mW in the perifovea. In 4 weeks after the laser stage, OCT, OCT-A, FAG are performed, with CRT of 400 mcm or more, IVIAI is performed, 4 weeks after the IVIAI, OCT is performed, IVIAI is carried out every 4 weeks to reduce CRT to a value less than 400 mcm, if observing the CRT in the fovea less than 400 mcm and the presence of visible dye transudation within microaneurysms on the FAG, repeated navigation topographically oriented laser coagulation of microaneurysms is performed with the following parameters: exposure 0.05 s, power 50 mW in parafovea and 100 mW in the perifovea.
EFFECT: method allows to increase the laser exposure accuracy and safety, reduce the number of microaneurysms, long-term reduce the height of cystic macular oedema, long-term increase the maximum corrected visual acuity, reducing a rate of postoperative complications.
1 cl, 3 ex
