Complications of laser coagulation of the retina

    People with diabetes have many vulnerabilities. These are different vessels of the limbs, vessels of the kidneys and vessels of the eyes. As a rule, it is the damage to the vessels of the eyes that is the cause, which can significantly worsen the quality of life of the patient. Today, there are techniques that can stop the pathological process in the eyes. This is laser coagulation of the retina. Like any other method, laser photocoagulation of the retina has its advantages and disadvantages. When does a patient with diabetic retinopathy need laser photocoagulation of the retina? What complications can occur after the procedure?

Laser coagulation of the retina - a way to treat diabetic retinopathy

    Laser photocoagulation of the retina is the most effective treatment for diabetic retinopathy. It is important to note that retinal coagulation is performed to prevent further progression of diabetic retinopathy and blindness. The effectiveness of the method is 80%, subject to timely treatment.

    The action of the laser stops the functioning of neoplasms in the vessels of the retina. It is these neoplasms that pose a threat to the organ of vision in the form of retinal detachment, hemophthalmos. rubeosis of the iris and secondary glaucoma.

Indications and contraindications for laser photocoagulation of the retina

Like all methods, laser coagulation has its own indications and contraindications. Indications are divided into absolute, relative and possible.

  Absolute:

• Hemorrhages (vitreal or preretinal) in association with newly formed vessels.
• Appearance of an outgrowth on the vessels of the optic nerve head of more than one third of its area with or without hemorrhages.

Relative:

• New vessel formation in the retina or iris with or without vitreal and preretinal hemorrhages.
• Formation of new vessels in the anterior chamber angle

  Possible:

• Diabetic retinopathy with moderate proliferation.
• Severe preproliferative diabetic retinopathy.

Contraindications for laser retinal photocoagulation:

• Hemorrhagic manifestations in the fundus.
• Gliosis III-IV degree with traction syndrome.
• Situations in which the media of the eye have poor transparency. This is clouding of the lens, cornea and destruction of the vitreous body.
• Poor visual acuity (

After reviewing the indications and contraindications for laser coagulation of the retina, you can proceed to the procedure itself. How is laser photocoagulation of the retina performed?

Method of laser photocoagulation of the retina

There are several methods of laser photocoagulation of the retina for the treatment of diabetic retinopathy.

Main Methods:

1. Barrier LKS – small coagulates are applied paramacularly in several rows, it is used in the combination of preproliferative diabetic retinopathy with edema of the spot area.
2. Focal LKS method - coagulates are applied in those areas where sodium fluorescein is translucent during angiography.
3. Panretinal retinal coagulation - the process of applying coagulates over the entire area of ​​the retina, except for the macular area. Used for pre- and proliferative stages of diabetic retinopathy.

The diameter and number of coagulates, as well as the energy of exposure, are determined individually for each patient & nbsp; for the treatment of diabetic retinopathy. The determination is based on recommendations based on the study of diabetic retinopathy, as well as the study of early treatment of diabetic retinopathy.

Duration of LCS courses in the treatment of diabetic retinopathy

The process of LKS in the treatment of diabetic retinopathy includes 3-4 sessions, because the simultaneous execution increases the risk of complications. At the same time, the number of coagulates ranges from 1500 to 2000. A more active tactic - in 2 sessions with an interval of one week, treatment is performed if:

- the process develops rapidly on one eye;

- with rapidly progressive proliferation in the presence of type 1 diabetes in a patient;

- a neoplasm on the vessels of the optic disc or anterior segment of the eye.

   A month after the treatment of retinopathy by coagulation of the retina, the patient must be notified of the mandatory visit to the ophthalmologist and endocrinologist. Further, the frequency of visits determines the severity of the process.

Complications of laser photocoagulation of the retina

   Before performing laser coagulation of the retina, the specialist must understand what complications can occur in which part of the eye and at what stage. The patient should also be informed that the procedure is not entirely safe. So, the complications that can occur with laser coagulation:

• Cornea - epithelial edema is possible.
• Anterior chamber - possible closure of the anterior chamber angle in combination with increased intraocular pressure. That's why. that a large amount of energy can provoke detachment of the choroid and swelling of the ciliary body.
• Iris – after the application of coagulates of large sizes, the formation of early synechia and deformation of the pupil are possible. In this case, the course should be interrupted and treated with glucocorticoids and mydriatics.
• Lens - possible progression of an existing cataract with narrow beam coagulation.
• Vitreous Body – it may appear turbidity, exudate or suspension of the pigment. The most common complication is repeated hemorrhage into the vitreous body, which provokes proliferative and destructive changes. For the treatment of hemophthalmos, transciliary vitreoretinal surgery is most effective.
• Retina - detachment and hemorrhage into the retina, development of cystic spot edema, impaired blood circulation in the optic nerve head are possible. In this case, the patient notes a decrease in visual acuity. Night blindness and visual field defects may also occur.
• Optical nerve - direct impact on the optic disc during coagulation of neoplasms on the vessel. It can lead to ischemia and decreased visual acuity.
• Pigmented epithelium and choroid - possible rupture of the membrane during coagulation with a narrow beam. At the same time, if during laser coagulation a retinal hemorrhage occurs, then it is necessary to create increased intraocular pressure by pressing a contact lens on the eye. Acute vascular occlusion of the choroid is also possible.

    Thus, laser photocoagulation of the retina is the main point in the treatment of retinopathy, especially diabetic neuropathy. It is important to remember that laser photocoagulation of the retina can have a number of complications, and also that this treatment only stops the pathological process.