scholarly journals The Effectiveness of Local Conservative Therapy after Panretinal Laser Coagulation against the Background of Diabetic Neuropathy

2021 ◽  
Vol 11 (3) ◽  
pp. 271-274
Author(s):  
Maria N. Ponomareva ◽  
Ivan M. Petrov ◽  
Evgeniya K. Gribanova
Keyword(s):  
Diabetic Neuropathy ◽  
Macular Edema ◽  
Laser Treatment ◽  
Conservative Therapy ◽  
Clinical Manifestations ◽  
Morphometric Parameters ◽  
Laser Coagulation ◽  
Panretinal Photocoagulation ◽  
Ophthalmological Examination ◽  
Scan Protocol

Background: Panretinal photocoagulation (PRP) (also called scatter laser treatment) remains one of the effective methods of treatment, and it can help to prevent blindness and low vision in diabetic retinopathy (DR). The aim of this study was to investigate the efficacy of local prolonged conservative therapy after PRP and the effect of somatic polymorbidity on visual functions in patients with diabetic neuropathy (DN) at the stage of clinical manifestations based on monitoring the clinical, functional and morphometric parameters of the macular region of the retina. Methods and Results: The study included 78 patients with type 2 diabetes (T2D) who underwent PRP for DR using a VISULAS® 532s solid-state laser (ZEISS). The patients were divided into two groups depending on the presence or absence of DN. Group 1 (n=60, 120 eyes) included patients with DN (stage of clinical manifestations), Group 2 (n=18, 36 eyes) included patients without DN. All patients underwent standard ophthalmological examination: visometry, tonometry, perimetry, biomicroscopy of the anterior segment of the eye and vitreous body, and fundus ophthalmoscopy. Thickness map of the retina was obtained using the RTVue-100 OCT (Optovue, Fremont, CA) EMM5 scan protocol and the Stratus OCT (Carl Zeiss Meditec, USA) radial scan protocol. After laser treatment, all patients, regardless of the treatment stage, were prescribed topically Broxinac® ( Bromfenac ophthalmic solution 0.09%), 1 drop twice a day for a month. In the presence of macular edema, a carbonic anhydrase inhibitor (Dorzolamide 2% solution) was added to the Broxinac® solution (1 drop twice a day) for up to 1 month after each PRP stage. The dynamics of CVA parameters and the retinal thickness of the macular region were assessed before PRP and 3 months after the complex treatment. Based on the monitoring of the clinical, functional and morphometric parameters of the macular region of the retina after PRP in T2D patients, we found a local, prolonged, 3-month conservative therapy to be effective, using the instillation of Broxinac® supplemented with Dorzolamide 2% solution in the presence of macular edema. Conversely, there is a negative effect of somatic polymorbidity (stage 3 chronic kidney disease), aspartate aminotransferase >40U/L) on corrected visual acuity (CVA) and morphometric parameters of the macular region of the retina during PRP in T2D patients with DN at the stage of clinical manifestations.

scholarly journals The Effectiveness of Laser Treatment for Diabetic Retinopathy in Patients with Chronic Kidney Disease

2021 ◽  
Vol 11 (4) ◽  
pp. 441-445
Author(s):  
Maria Ponomareva ◽  
Ivan Petrov ◽  
Evgeniya Gribanova²
Keyword(s):  
Chronic Kidney Disease ◽  
Diabetic Retinopathy ◽  
Kidney Disease ◽  
Laser Treatment ◽  
Panretinal Photocoagulation ◽  
Ophthalmological Examination ◽  
Ckd Stage ◽  
Group 2 ◽  
Scan Protocol ◽  
Group 1

Background: Panretinal photocoagulation (PRP) remains one of the effective methods of treatment in pre- and proliferative forms of retinopathy with high efficiency. The aim of this study was to investigate the efficacy of PRP depending on the somatic status, laboratory parameters, and the severity of chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) and a history of diabetic retinopathy (DR). Methods and Results: The study included 76 patients (50 women and 26 men) with T2D who underwent PRP for DR (152 eyes) using a VISULAS® 532s solid-state laser (ZEISS). The patients were divided into two groups depending on the severity of CKD. Group 1 (n=32, 64 eyes) included patients with CKD Stage 1, Group 2 (n=44, 88 eyes) included patients with CKD Stage 2. All patients underwent standard ophthalmological examination: visometry, tonometry, perimetry, biomicroscopy of the anterior segment of the eye and vitreous body, and fundus ophthalmoscopy. Thickness map of the retina was obtained using the RTVue-100 OCT (Optovue, Fremont, CA) EMM5 scan protocol and the Stratus OCT (Carl Zeiss Meditec, USA) radial scan protocol. Laboratory methods included a general blood test, PPG, FG, HbA1c, general urine analysis, and the assessment of blood levels of creatinine, ALT, and AST. PRP was carried out according to the standard method, gradually, in three stages; the interval between the stages of laser treatment was 1 month. After laser treatment, all patients, regardless of the treatment stage, were prescribed topical Broxinac® (Bromfenac ophthalmic solution 0.09%). The dynamics of corrected visual acuity (CVA) parameters and the retinal thickness of the macular region were assessed before PRP and 3 months after the complex treatment. Multivariate analysis revealed a linear and nonlinear effect of lipid spectrum indicators (TC and LDL) on the formation of CL (crystalline lens) pathology. After treatment, a significant increase in CVA was noted in both study groups. The effectiveness of PRP coagulation depended on the severity of the CKD stage in T2D patients with DR. Normalization of morphometric parameters of the macular region of the retina was noted in 93.8% of cases in Group 1 and in 86.4% of cases in Group 2. The decrease in the effectiveness of treatment was associated with the presence of macroangiopathy (CAD), concomitant diseases (CHF, AH and dyslipidemia), and CKD stage. Conclusion: Prolonged administration of the non-steroidal, anti-inflammatory drug Bromfenacum® for a month after each stage of PRP is effective.

scholarly journals Features of pathological changes in the retina and vitreoretinal interface in the macular zone in patients with diabetic macular edema

2021 ◽  
Vol 6 (6-1) ◽  
pp. 136-143
Author(s):  
E. V. Boiko ◽  
D. Kh. Oskanov ◽  
S. V. Sosnovskii
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Morphometric Parameters ◽  
Ophthalmological Examination ◽  
Optical Coherence ◽  
Pathological Changes ◽  
Vitreoretinal Interface ◽  
Corrected Visual Acuity

Background. Diabetic macular edema (DME) is one of the main causes of decreased central vision. Determining the reasons for the refractoriness of DME to treatment is an urgent problem.Aims. Based on the analysis of optical coherence tomography, to study the features of pathological changes in the retina and vitreoretinal interface (VRI) in the macular zone in patients with DME.Materials and methods. We studied 587 patients (587 eyes) with diffuse DME in the setting of nonproliferative diabetic retinopathy. In addition to the standard ophthalmological examination, everyone underwent optical coherence tomography of the macular zone with an assessment of structural changes in the retina, morphometric parameters, and the state of the VRI.Results. In 351 patients (59.80 %) with DME, pathological variants of the VRI were revealed, in which the best corrected visual acuity was significantly lower, and the morphometric parameters (retinal thickness and macular volume) were signifi cantly higher. Analysis of morphostructural changes in the macular zone revealed that in pathological VRI, neuroepithelial detachment and high edema are more common, and cystic edema is larger in area compared to the group with a normal VRI. With detachment of neuroepithelium against the background of a pathological VRI, the worst morphometric data are determined, with solid exudates in the macula, the worst indices of visual loss are determined.Conclusions. The pathological VRI in patients with diabetic macular edema occurs in more than half of the cases and is characterized by a high incidence of neuroepithelial detachment, high edema, higher morphometric parameters with worse visual acuity. At the same time, the presence of neuroepithelial detachment corresponds to the worst morphometric indicators of the macular zone, and the presence of solid exudates corresponds to a lower maximum corrected visual acuity. Further research is needed to assess the effect of the listed morphostructural and morphometric changes in combination with various pathological variants of VRI on the effectiveness of DME treatment.

scholarly journals Subthreshold lasercoagulation (810 nm) for diabetic macular edema

2018 ◽  
Vol 11 (4) ◽  
pp. 15-20
Author(s):  
Aleksandr S. Izmaylov ◽  
Tat’yana V. Kotsur
Keyword(s):  
Macular Edema ◽  
Laser Treatment ◽  
Diode Laser ◽  
Diabetic Macular Edema ◽  
High Density ◽  
Laser Coagulation ◽  
Retinal Edema ◽  
Grid Pattern ◽  
Significant Difference ◽  
Subthreshold Laser

Introduction. The threshold laser coagulation leads to irreversible damage of retinal structures, microscotomata appearance in the central visual field, contrast sensitivity decrease, and color vision impairment, being accompanied as well by the release of proinflammatory cytokines. For diabetic macular edema treatment, a method of high-density subthreshold laser coagulation (810 nm) was first developed, based on individualized choice of subthreshold parameters of laser irradiation, and permitting confluent application of laser impacts to the retina. Using multimodal diagnostic approach to the estimation of anatomic and functional treatment results, a minimally invasive character and safety of this DME treatment method were confirmed. Purpose. The aim of this study was to comparatively evaluate the efficacy of a diode laser (810 mn) subthreshold laser treatment using high-density laser impact application in diode laser coagulation (DLC) and diode microphotocoagulation (DMP) modes. Materials and methods. To compare the efficacy of subthreshold laser treatment methods (DLC and DMP), patients were divided into two groups, comparable in macular edema thickness and area. The first group (24 eyes) received a macular laser coagulation in grid pattern and MicroPulse diode laser (810 nm) regimen; biomicroscopically it was predominantly subthreshold high-density application of burns. The second group (29 eyes) received a macular laser coagulation in grid pattern and continuous diode laser (810 nm) regimen; biomicroscopically it was predominantly subthreshold high-density application of burns. Results. After DLC and DMP, there was no statistically significant difference between compared groups in best corrected visual acuity. There was also no significant difference in retinal edema maximal height dynamics, retinal edema area, and central thickness in 2 and 4 months. Conclusion. Subthreshold microphotocoagulation and laser coagulation methods at the same average power of laser exposure and other exposure parameters in the shortterm follow-up have comparable efficacy in the treatment of diabetic macular edema.

Clinical and Radiographic Correlation (According to CT) in Patients with Degenerative Lumbar Spinal Stenosis

2017 ◽  
pp. 124-130 ◽  
Author(s):  
S. G. Mlyavykh ◽  
A. Y. Aleynik ◽  
A. E. Bokov ◽  
M. V. Rasteryaeva ◽  
M. A. Kutlaeva
Keyword(s):  
Ct Scan ◽  
Spinal Canal ◽  
Clinical Manifestations ◽  
Intervertebral Discs ◽  
Morphometric Parameters ◽  
Neurogenic Claudication ◽  
Clinical Group ◽  
Lumbar Stenosis ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Lumbar Spinal

Сomputed tomography (CT) is widely used in the diagnosis of  degenerative pathology of the lumbar spine, but the relationship  between clinical manifestations of lumbar stenosis and its anatomical prerequisites has not been sufficiently studied to date.The objective: to determine the significance of the morphometric  parameters of lumbar stenosis according to CT scans and to  establish their relationship with the prevailing symptoms of the disease.Material and methods. Seventy-five consecutive patients with  clinically significant lumbar stenosis who underwent CT scan before  surgery were enrolled in this study. The average values of thirteen  different morphometric parameters were calculated at LIII–SI levels of the intervertebral discs and of the pedicels in the axial and sagittal views. The possibility of classification of clinical observations and the correlation of morphometric parameters with the clinical forms of lumbar stenosis were investigated using discriminant and logistic regression analysis. Results. CT scan with high probability allocates patients with  predominant symptoms of neurogenic claudication or bilateral  radiculopathy. The most significant morphometric predictors of this  clinical group are the depth of the lateral recesses and the cross-sectional area of the spinal canal.Conclusion. CT scan significantly expands the informative value of  magnetic resonance imaging and can be used in planning the  decompressive stage of the surgery intervention in patients with lumbar spinal canal stenosis.

Comparative efficacy of micropulse laser treatment of diabetic macular edema

2019 ◽  
pp. 24-27
Author(s):  
M.Y. Guro ◽  
◽  
Y.Y. Khzardzhan ◽  
V.N. Potapova ◽  
A.S. Balalin ◽  
...  
Keyword(s):  
Macular Edema ◽  
Laser Treatment ◽  
Diabetic Macular Edema ◽  
Comparative Efficacy ◽  
Micropulse Laser

Cesarean scar defects: diagnosis and treatment in non-pregnant women

GYNECOLOGY ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. 6-10
Author(s):  
Sergey A. Martynov
Keyword(s):  
Magnetic Resonance Imaging ◽  
Surgical Treatment ◽  
Magnetic Resonance ◽  
Genital Tract ◽  
Conservative Therapy ◽  
Clinical Manifestations ◽  
Subsequent Pregnancy ◽  
Resonance Imaging ◽  
Diagnostic Features ◽  
Pregnancy And Childbirth

The aim of the review was to summarize information on clinical manifestations, diagnostic features, as well as methods for correction of scar defects after cesarean section (CS) outside pregnancy. Lack of the scar after CS, niche, isthmocele are a myometrium defect in the area of scar after CS, which is most often detected by ultrasound, sonohysterography or magnetic resonance imaging and is manifested by postmenstrual bleeding from the genital tract. In some cases, it can cause menorrhagia, dyspareunia, pelvic pain, infertility, uterine rupture during subsequent pregnancy and childbirth. Conservative therapy or surgical treatment with laparoscopy, laparotomy or vaginal approach is carried out depending on the symptoms, size of the defect, the thickness of the residual myometrium, as well as the womans reproductive plans.

scholarly journals Subthreshold Micropulse Laser Modulates Retinal Neuroinflammatory Biomarkers in Diabetic Macular Edema

2021 ◽  
Vol 10 (14) ◽  
pp. 3134
Author(s):  
Luisa Frizziero ◽  
Andrea Calciati ◽  
Giulia Midena ◽  
Tommaso Torresin ◽  
Raffaele Parrozzani ◽  
...  
Keyword(s):  
Macular Edema ◽  
Laser Treatment ◽  
Diabetic Macular Edema ◽  
Metabolic Pathways ◽  
Treatment Method ◽  
Micropulse Laser ◽  
Subthreshold Micropulse Laser ◽  
Inflammatory Processes ◽  
Standardized Parameters

Subthreshold micropulse laser treatment has become a recognized option in the therapeutic approach to diabetic macular edema. However, some yet undefined elements pertaining to its mechanism of action and most effective treatment method still limit its clinical diffusion. We reviewed the current literature on subthreshold micropulse laser treatment, particularly focusing on its effects on the modulation of retinal neuroinflammation. Subthreshold micropulse laser treatment seems to determine a long-term normalization of specific retinal neuroinflammatory metabolic pathways, contributing to the restoration of retinal homeostasis and the curtailing of local inflammatory processes. Optimized and standardized parameters ensure effective and safe treatment.

MACULAR EDEMA FOLLOWING PANRETINAL PHOTOCOAGULATION

Retina ◽  
1985 ◽  
Vol 5 (1) ◽  
pp. 5-10 ◽  
Author(s):  
H RICHARD McDONALD ◽  
HOWARD SCHATZ
Keyword(s):  
Macular Edema ◽  
Panretinal Photocoagulation

The first experience of application of vessel endothelium growth factor inhibitor ranibizumab in complex therapy of retinopathy of premature in URFO in SAHI of the Sverdlovsk region MСMC «Bonum»

2021 ◽  
pp. 360-362
Author(s):  
M.A. Kariakin ◽  
◽  
E.A. Stepanova ◽  
S.A. Korotkikh ◽  
N.S. Timofeeva ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Intravitreal Injection ◽  
Laser Treatment ◽  
Retinopathy Of Prematurity ◽  
Laser Coagulation ◽  
Complete Regression ◽  
Complex Treatment ◽  
Partial Regression ◽  
Factor Inhibitor ◽  
Retinal Adhesion

Material and methods. The study included 16 patients (31 eyes). Types and terms of treatment. Stage I in the treatment of ROP, laser coagulation of the avascular areas of the retina was performed in three patients with aggressive posterior ROP (4 eyes, 12.9%). In all patients, the progression of the disease was noted. Intravitreal injection of ranibizumab was performed in the period from 8 to 16 weeks (10.5±2.0 weeks), PCV from 32.3 to 39.6 weeks (37.0±1.8 weeks). Result. After laser treatment and IVI of ranibizumab, 11 patients (31 eyes, 81.6%) showed regression of the disease. In 5 patients (6 eyes, 19.4%) - progression. If the ROP progressed, a 25G or 27G lenssparing vitrectomy was performed. Complete regression of ROP was achieved in one patient (1 eye, 16.7%). Partial regression was observed in two patients (2 eyes, 33.3%). In two patients (3 eyes, 50%), the disease progressed to stage 5 with the development of total retinal detachment. Conclusion. As a result of the complex treatment of severe forms of the active stage of retinopathy of prematurity in the regional children's ophthalmological center MKMC "Bonum" in Yekaterinburg, the following data were obtained: complete regression with retinal adhesion is observed in 12 patients (26 eyes, 83.4%), of which in one patient (1 eye, 3.2%) regression was achieved after vitrectomy. Partial regression with the formation of a peripheral retinal detachment after vitrectomy was achieved in two patients (two eyes - 6.5%). Progression of retinopathy of prematurity to stage V with the development of total retinal detachment in two patients (3 eyes, 9.6%). Complex treatment of severe stages of active ROP using laser treatment, IVI and vitrectomy allows to preserve vision in 90.4% of patients. Key words: retinopathy of prematurity; intravitreal injection; laser coagulation of the retina; vitrectomy.

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