Purpose. To optimize the stages of navigation laser coagulation technology of the retina for its implementation in active retinopathy of prematurity (ROP), taking into account the anatomical and topographical features of the disease. Material and methods. Transpupillary navigation laser coagulation of the avascular retina was performed on 28 eyes of children with an unfavorable type of active ROP. Of these children, 17 are with stage 2 and 11 are with stage 3 of the disease. Laser coagulation of the avascular retina was performed using a Navilas 577s laser system (OD-OS, Germany). To realize the possibility of performing navigational laser coagulation of the retina in children with ROP, the technology was optimized at 3 stages: photo registration, planning and laser treatment itself. Results. The optimization of the main stages of navigational laser coagulation of the retina (photo registration, planning, treatment) in children with active ROP made it possible to fully realize the advantages of the Navilas 577s laser system: an individual treatment plan taking into account the area and configuration of the avascular zone in each specific case, automatic execution laser coagulation of the retina with absolute adherence to the principle of hexagonality (equidistance) of spots throughout the laser exposure zone, high positioning accuracy and safety of application due to an automatic tracking system for the patient’s eye movement, maximum speed and minimum duration of coagulation. Conclusion. Obtained results demonstrate the possibility of automating laser treatment in the avascular zone of the retina, regardless of its area, with the full implementation of the advantages of navigational laser coagulation of the retina. This opens up prospects for application of this technology in children with active stages of ROP in wide clinical practice. Key words: retinopathy of prematurity, navigation laser coagulation of the retina, optimization

Aim: to evaluate the efficacy of transpupillary hexagonal pattern laser coagulation of the retina (LCR) in the treatment of active stages of retinopathy of prematurity (ROP). Patients and Methods: from 2017-2020, transpupillary LCR was performed for 161 infants (161 eyes) with an unfavorable course of ROP, active stages 2 and 3. All infants were divided into the study and control groups. Patients of both groups received laser treatment with the Integre Pro Scan 561 nm pattern system (Ellex, Australia). In the control group (n=83), LCR was performed with the chosen square matrix patterns 3×3 (totally 9 applications). In the study group (n=78), the "honeycomb" LCR was performed using a hexagonal pattern (totally 7 applications). Coagulation parameters in the study and control groups differed only in the interval between laser applications. The inter-spot distance was increased by 0.25 of the coagulum diameter in the study group as compared to the control group. The treatment efficacy was evaluated by changes in the clinical manifestations (flattening, decrease and disappearance of the extraretinal proliferation (ERP) ridge and demarcation ridge) and morphometric indicators (reduction in retinal thickness in the macular region) 3–4 weeks following LCR. Results: the efficacy of the hexagonal pattern LCR technique is comparable to that of the square pattern LCR: in both groups it was effective in 100% of patients with ROP stage 2 and 96% of patients with ROP stage 3. In patients treated with the hexagonal pattern LCR, the total number of coagulates, number of single coagulates, total energy load and the total treatment time were less than those in patients for whom the square matrix patterns were used. The hexagonal pattern shape is convenient for performing treatment close to the extraretinal proliferation ridge, as a topographically oriented LСR session can be performed on a case-by-case basis, considering individual characteristics of the pathological process location. The technique was optimal for treating the spherical retinal surface of a premature baby and provided an accurate and intuitive "docking" of every next pattern to the previous one. Conclusion: the hexagonal pattern LCR is a tissue-saving, dosed and high-precision technique which enables to achieve an adequate clinical effect minimizing the energy load on the retina of a premature baby. Keywords: active stages of retinopathy of prematurity, transpupillary pattern laser coagulation of the retina, hexagonal pattern, "honeycomb" pattern, matrix pattern, extraretinal proliferation (ERP) ridge. For citation: Tereshchenko A.V., Trifanenkova I.G., Sidorova Yu.A., Firsova V.V. Evaluation of the efficacy of transpupillary hexagonal pattern laser coagulation of the retina in the treatment of active stages of retinopathy of prematurity. Russian Journal of Clinical Ophthalmology. 2023;23(1):39–46 (in Russ.). DOI: 10.32364/2311-7729-2023-23-1-39-46

Purpose is to demonstrate the first experience of the automated navigation system “Navilas” using in the treatment of active stages of retinopathy of prematurity (ROP) in the Kaluga branch of “Eye Microsurgery” complex. Material and methods. Transpupillary retinal laser coagulation (RLC) using the “Navilas 577s” navigation system (OD-OS, Germany) was performed in 5 premature infants with an unfavorable type of stages 2nd and 3rd of active ROP. The postconceptual age (PCA) at the time of treatment was 34–37 weeks. Body weight at birth – from 900 to 1900 g, gestation age – 27–33 weeks. Results. The “Eye tracking” function ensured the absolute accuracy of the laser spots, as well as the uniformity and safety of their application during the automated navigation RLC. After 1 month, the formation of chorioretinal atrophy zone with heterogeneous pigmentation was noted in all patients at the site of the RLC. The growth of retinal vessels into the avascular retina in the direction of ora serrata was observed. Conclusion. The first experience has shown that RLC of the avascular retina on the automated navigation system “Navilas” is safe, precision, metered, topographically oriented, which in the future will allow to standardize the technique of laser treatment for patients with ROP active stages. Keywords: retinopathy of prematurity, unfavorable type, navigation retinal laser coagulation.

Purpose – to conduct a retrospective analysis of the results of episcleral filling in the surgical treatment of primary rhegmatogenous retinal detachment. Material and methods. Patients diagnosed with rhegmatogenous retinal detachment whom were undergone episcleral filling from 2015 to 2020 at the S. Fyodorov Eye Microsurgery Federal State Institution, the Kaluga Branch, were performed to a detailed retrospective analysis. Additionally, cases were analyzed when, after episcleral filling, the retina did not attach and later vitreoretinal surgery was performed. Results. Episcleral surgery was performed to the 486 eyes, repeated interventions were required to 126 eyes (26%). The presence of peripheral chorioretinal dystrophy of the retina (PCHDR) in paired eyes was found in only 45% of patients. In these patients’ retinal attachment was achieved with only one episcleral filling. In cases of lack of retinal attachment after episcleral surgery, the proportion of the presence of PCHDR in the paired eye was 84%. The superior and temporal segments were the most frequent places of localization of retinal rupture. At the same time, there were retinal ruptures in the upper segment in 30% of patients. The proportion of rupture in the external segment was 32%. The retinal rupture was localized in the upper external segment at 18% of cases. At 20% of cases, retinal ruptures were localized in the lower external and lower segments. Conclusion. The success of episcleral surgery depends on the thoroughness of the diagnosis, the detection of all existing retinal ruptures and their blocking during the surgical treatment. Key words: rhegmatogenous retinal detachment, episcleral filling, intravitreal surgery.

Purpose. To substantiate mathematically the tissue-preserving effect on the retinal hexagonal pattern during the laser treatment of active retinopathy of prematurity.Material and methods. At the first stage of the study, a mathematical rationale of the application of a hexagonal pattern was carried out to provide a tissue-sparing effect on the retina compared to the traditional laser coagulation pattern with matrix (rectangular) patterns.The second stage was performed as clinical studies in two groups of patients with an unfavorable course type II and III stages of active ROP. The main group consisted of 44 infants, which underwent hexagonal Fyodorov Journal of Ophthalmic Surgery. 2020;1: 40–46.laser coagulation (7 applications in one «honeycomb» pattern). The control group involved 41 infants who had a matrix laser coagulation (9 applications in one «rectangular» pattern).Results. At the first stage, it was proved that the hexagonal shape of the pattern is mathematically substantiated and ensures a uniform distribution of laser applicates on the spherical surface of the retina due to the equidistant location of the spots inside one pattern and optimal matching of neighboring patterns.As a result of the second stage of research in both groups, a regression after laser treatment was obtained in more than 97% of cases at the ROP stage 2 and in 94% of cases at the ROP stage 3. The total energy load in the main group was less than in the control group. The increase in the inter-spot distance in the hexagonal pattern by 0.25 of the coagulum diameter in comparison with the matrix pattern made it possible to maintain a high clinical efficacy and to ensure tissue-preserving effects on the retina.Conclusion. Optimization of the pattern laser coagulation method using a hexagonal-shaped pattern allows to shorten the duration of the intervention maintaining a high clinical efficacy in the treatment of active ROP.

Цель. Изучить эффективность гексагональной паттерновой лазеркоагуляции сетчатки (ЛКС) при активной ретинопатии недоношенных (РН) в сравнении с матричной паттерновой ЛКС. Материал и методы. С 2017 по 2019 гг. в Калужском филиале МНТК транспупиллярная ЛКС была проведена у 142-х младенцев (161 глаз) с активными стадиями РН. Всем пациентам лазерное лечение проводилось на паттерновой системе «Integrе Pro Scan» 561 нм (Ellex, Австралия). В основной группе выполняли ЛКС с использованием паттерна гексагональной формы (суммарно 7 аппликатов) – 69 детей. В контрольной группе ЛКС проводили с использованием матричных паттернов 3*3 (суммарно 9 аппликатов) – 73 младенца. Межспотовое расстояние в основной группе было увеличено на 0,25 диаметра коагулята по сравнению с контрольной. Результаты. Гексагональная паттерновая ЛКС обеспечила регресс заболевания при 3-«пороговой» стадии на 112 глазах (97%), при задней агрессивной РН на стадии ранних клинических проявлений – на 10 глазах (86%), на стадии манифестации – на 6 глазах (75%). Регресс заболевания при проведении стандартной паттерновой ЛКС с использованием квадратной матричной решетки на 3-«пороговой» стадии был отмечен на 109 глазах (96%), при задней агрессивной РН на стадии ранних клинических проявлений – на 8 глазах (80%), на стадии манифестации – на 4 глазах (66,7%). Длительность лазерного лечения, суммарная энергетическая нагрузка, частота использования одиночных импульсов в основной группе были значительно меньше, чем в контрольной. Заключение. Гексагональная паттерновая ЛКС обеспечивает высокую эффективность лазерного лечения активной РН и позволяет сократить продолжительность сеанса лечения по сравнению с матричной паттерновой ЛКС. Уменьшение плотности гексагональной ЛКС по сравнению с матричной приводит к уменьшению суммарной энергетической нагрузки на сетчатку глаза недоношенного ребенка с сохранением высокой клинической эффективности метода.

Diabetic cataracts in combination with diabetic macular edema (DME) is a leading cause of vision loss i n patients with diabetes mellitus.Purpose. To evaluate the efficacy and safety of one-stage combined treatment of patients with diabetes complicated by DME and cat aract.Material and methods. This study involved 16 patients with diabetes of the type 2 (32 eyes). The main group included 16 eyes with complicated cataracts, who underwent the simultaneously performed phacoemulsification of cataract (FEC) with IOL implantation and intravitreal implantation of the «Ozurdex» implant. The second (retrospective control) group included 16 fellow eyes, where a standard FEC with IOL implantation was performed.Results. Six months after the treatment, the main group showed a BCVA stabilization at a level 0.25±0.12 (0.1-0.4). In the retrospective group, the BCVA decreased and reached a baseline level 0.1±0.05 (0.05-0.2), in 5 patients the BCVA became below the baseline values. In all cases in the main group, a partial resorption of «solid» exudates was observed in the macular area. Edema of the retina decreased by 102-275 microns in comparison with preoperative indicators, the average retinal thickness was 385±58 microns in fovea area. Diffuse macular edema with a deposition of «solid» exudates remained in the retrospective control group, all patients had an increase in the amount of intra-etinal hemorrhages. In 5 patients, not only an increase in the number of «solid» exudates was revealed in the dynamics, but also their spread to the fovea region, in 3 cases the exudation foci acquired the form of hyper-reflective layers. The increase in the edema height occurred in all cases by 74-144 microns, index of average retinal thickness was 598±76 microns. In 7 cases, the dynamics showed an increase in flat subfoveal detachments of the neurosensory retina.Conclusions. The complex effect of the OzurDex drug in the combined treatment of diabetic cataracts in combination with DME reduces a risk of inflammatory complications in the early postoperative period, and also provides a reduction in the height of edema and partial resorption of «solid» exudates.