Peripheral laser coagulation. Laser coagulation of the retina. Most common causes of retinal detachment

Laser coagulation retinal is carried out with ruptures and thinning of the retina. Retinal breaks can sometimes be manifested by the appearance of "flashes", "lightning" in front of the eye. But more often there are so-called "silent" breaks that the patient does not feel in any way (while they may be accompanied by subclinical retinal detachment).

Symptoms of violations of the integrity of the retina

Retinal tears can sometimes present with the following symptoms:

flashes of light, lightning or glare before the eyes, usually observed in the dark;
the appearance of "midges" before the eyes;
decreased visual acuity;
narrowing of the visual fields;
distorted vision and perception of objects;
"fog" or "veil" before the eyes.

The danger of the disease is that in most cases, the symptoms of retinal rupture are absent or mild. However, they may be accompanied by subclinical. Only an experienced ophthalmologist can make a correct diagnosis when examined using special equipment.

Causes of retinal changes

when changes occur in the physiology and anatomy of the eye;
significant changes in the blood supply and circulation of the eye;
age-related visual impairment in people with farsightedness, and even in people with normal vision;
contributing factors: excessive exercise, head injuries, neurological problems, stress and a sharp increase in blood pressure.

Disease prevention

The occurrence and development of retinal tears can be avoided by following simple recommendations for prevention:

Timely access to specialists for diagnosis and treatment;
Patients with retinal pathology, as well as patients at risk (with myopia) should be examined 1-2 times a year, since the likelihood of new retinal breaks exists throughout life
During pregnancy, it is necessary to be observed by an ophthalmologist and examine the retina (through a wide pupil) at least twice - at the beginning and at the end of pregnancy. In the presence of thinning or ruptures of the retina, preventive laser coagulation of the retina is mandatory. In addition, with this pathology, independent childbirth may be contraindicated.
After childbirth, women with retinal pathology should visit an ophthalmologist no later than 1-3 months after them.

Treatment of retinal breaks. Laser coagulation

When ruptures and thinning of the retina are detected, treatment is carried out - prophylactic laser coagulation of the retina or delimiting laser coagulation of the retina. Retinal coagulation is a microsurgical laser operation, during which a special laser beam creates microadhesions (coagulates) of the retina with the underlying choroid around weak areas of the retina.

Scheme of laser coagulation

With the help of a special laser, the retina is affected along the edge of the rupture, and thus the rupture zone is "glued" (scarring) to the underlying membranes of the eye, which prevents the liquid from penetrating under the retina and exfoliating it in this place.

Laser coagulation is performed on an outpatient basis, takes a few minutes and is well tolerated even by children. During laser coagulation of the retina, a local, easily tolerated anesthesia is used.

In some cases, for example, with insufficiently transparent eye media, cryopexy of the rupture zone (cold treatment) is performed through the conjunctiva of the posterior wall of the eye. This procedure can also be performed on an outpatient basis. Modern lasers make it possible to treat not only thinning and ruptures, but also subclinical (i.e. small) and even flat limited retinal detachments

Postoperative period

It does not matter which version of the operation is performed - delimiting retinal coagulation or prophylactic, in order to maintain a stable result and safety for health, it is important to remember about proper rehabilitation. Within 2 weeks, you should refuse:

From any activity accompanied by shaking or vibration;
From alcoholic drinks and smoking;
From the positions of the body in a dream, in which the level of the head is lower than the level of the legs;
From lifting weights and other physical activities.

When is coagulation indicated?

with peripheral retinal dystrophies;
in some cases with retinal vein thrombosis;
in some cases with central serous chorioretinopathy;
with retinal angiomatosis;
with local detachment of the retina.

When the procedure is contraindicated

lack of transparency in the eyes
widespread retinal detachment

Diagnosis in the preoperative period

The diagnostic program for coagulation includes:

intraocular pressure measurement
visual acuity test
fundus examination
ultrasound procedure
if necessary and the presence of concomitant diseases, clinical analyzes are collected

What happens if you do not carry out laser coagulation?

In cases where retinal breaks are not diagnosed and treated on time, a common one may occur, which is a dangerous complication that can lead to blindness. Then the patient comes to the doctor with complaints of a sharp, sudden decrease in vision. In this case, surgical treatment is indicated, however, it is not always possible to “put” the detached retina back in place, unfortunately, “lost” vision may not return. Even after "successful" coagulation operations, visual acuity is rarely restored to the original. Usually it is lower.

Laser coagulation of the retina is an operation performed under local anesthesia. Ninety percent of patients can boast that this manipulation occurs calmly. Modern medical technology is able to act on the affected areas with maximum accuracy. As a result of such an operation, a slight destruction of the retina protein occurs, which subsequently leads to sealing of the affected area.

With the timely implementation of the procedure, the disease stops progressing.

Restrictive laser coagulation of the retina of the eyeball is performed in a medical center, and the duration of the operation is no more than twenty minutes. A special lens is put on the patient, the purpose of which is to direct the laser beams to the necessary layer of the fundus. The affected areas are fixed with coagulants. The period of restoration and creation of a certain strength of the connection takes about two weeks. During this time period, any physical activity is prohibited, as they can disrupt the recovery processes.

Laser exposure leads to a sharp increase in temperature, which causes tissue coagulation

Laser coagulation of the retina, what is it? Peripheral prophylactic laser coagulation (PPLC) is an effect aimed at strengthening areas located on the periphery. In addition, the procedure can be used as an obstacle to the formation of detachments of the retinal lattice of the eyeball. The technique itself is based on a certain effect on the thinned areas of the retina. The laser carries out soldering of the retina in problem areas. The main task of coagulation is to normalize the blood circulation of the visual organs and enhance the process of equipping the retina with nutrients.

Experts in this field say that this measure is necessary in sixty percent of cases. Failure to take preventive measures can lead to irreversible consequences. PPLC is a preventive measure designed to maintain the health of the visual organs.

When is laser exposure necessary?

It should be noted that laser coagulation of the retina is the only preventive measure designed to maintain visual acuity. Unfortunately, there are no analogues of this technique today. The operation should be performed in the following cases:

diagnosing anomalies of the eye veins;
thrombosis of the central vein of the retina;
formations on the retina of the eyeball;
detachment of the retina;
diseases associated with excessive proliferation of blood vessels;
crushing of the optic nerve.

Before contacting a specialist, it is worth learning about a number of contraindications. So, laser intervention is not recommended for people with the following diagnoses;

hemorrhages in the fundus;
opacity of the optical lens;
iris neovascularization;
excessive detachment of the retina;
pregnancy.

The laser has a very high precision and is used to create adhesions between the retina and the choroid of the eye.

Causes of retinal detachment

The following reasons can cause retinal detachment: myopia, the appearance of various tumors, nutritional disorders, and mechanical damage. As a result, there is a tension of the mesh lattice and a rupture occurs. Through the gaps formed, the fluid in the vitreous body enters under the retina, where it begins to accumulate. Such detachment can lead to disruption of the blood supply to the eyeball.

Operation technique

Retinal laser treatment can be performed using several methods. The final method depends on the localization of the pathology. The principle of focal laser coagulation is based on a single laser effect on the lesion. In contrast, the method of restrictive coagulation is that the coagulants are applied in stages, creating a certain circle of the center of the mesh lattice. Panretinal exposure is performed at several points.

Today, laser coagulation can be carried out in many medical centers. Before the start of the operation, a special composition is dripped into the patient's eyes, which contributes to the expansion of the pupil and has an anesthetic in its composition. After the anesthetic begins to act, the patient is placed in front of the laser device and the head is pressed tightly against a special place. The gaze should be focused on a certain point, after which the equipment is set up.

The stages of the operation are fully tracked on a special screen. During the operation, many patients complained of bright flashes of light, but this does not affect their further well-being. The duration of such an operation on average takes about thirty minutes. Upon completion, the specialist can immediately evaluate the result. After the diagnosis, the patient goes home.

Degenerative processes in the retina are most often observed in patients with high and moderate myopia.

There are some limitations after laser photocoagulation of the retina. So, for example, experts recommend in the early days to stop wearing optical lenses and glasses, as well as any actions related to the strain of the organs of vision. Laser treatment of diseases of the organs of vision is one of the best methods aimed at improving vision and restoring blood circulation.

Advantages of the method

The laser coagulation technique has the following advantages:

The absence of the risk of introducing infectious diseases and getting various injuries is due to the fact that the procedure is performed without direct contact with the fundus of the eye.
The painlessness of the technique, as well as the absence of bruising, both during the operation itself and during the rehabilitation period.
During the procedure, local anesthesia is used, which minimizes the consequences associated with the cardiovascular system.
This procedure can be carried out in the early stages of pregnancy, however, if such a need arises, you should consult with your doctor.
The operation is performed on an outpatient basis, which means that after taking all the necessary measures, you can immediately go home.

Cauterization of the retina with a laser is an operation, the outcome of which, in ninety percent of cases, is successful.. But sometimes patients turn to specialists only at the extreme stages of exacerbation.

It is also very important that a one-time intervention is not always enough to achieve a certain effect. Another factor that may lead to re-intervention is the suspicion of a possible relapse.

Possible Complications

The negative consequences of PPLC of the retina of the eyeball are almost reduced to zero. In rare cases, there is the occurrence of conjunctivitis and clouding in the eye environment. Other complications can cause discomfort, expressed as burning and redness in the eyes, but these consequences are not dangerous.

Laser coagulation of the eyes is bloodless and does not last very long, up to 20 minutes

Conjunctivitis- one of the rare phenomena that manifests itself after laser coagulation of the retina. It is an inflammation of the mucous membrane of the eye. Expressed by a strong burning sensation, swelling of the eyelids and lacrimation. In the advanced stage or when an infection occurs, pus may appear. In the event of a disease, you should immediately contact an ophthalmologist to obtain the necessary recommendations and prescribe medications.

Dangerous consequences include opacities in the optical environment of the eyeball. This issue requires a careful approach and diagnosis. The consequences that pathology can lead to is loss of vision. Therefore, it is important to start treatment in a timely manner.

rehabilitation period

Despite the fact that there is no rehabilitation period after laser coagulation of the retina, there are a number of recommendations that require impeccable implementation. After a few hours, after the procedure, the action of the composition that expands the pupil ends. After that, vision begins its recovery and acquires its former sharpness. This moment may be accompanied by irritation and redness of the eyeball. Symptoms disappear on their own after a certain time and do not require any measures.

It is forbidden to drive vehicles during the rehabilitation period, as with eye strain, gaps in adhesions may form. It is worth getting behind the wheel only after two weeks have passed since the operation. During this period, it is recommended to wear sunglasses.

After laser coagulation of the retina has been performed, the postoperative period is two weeks, during which you should refrain from the following actions:

exercises in the gym and fitness centers;
lifting weights and loads;
it is strictly forbidden to influence, entailing falls, vibrations and tremors;
visual loads are not recommended (working at a computer, watching TV, using phones and tablets);
it is necessary to refrain from drinking alcohol, foods high in salt, and large volumes of liquids;
visiting beaches, open reservoirs, swimming pools, baths and saunas.

Following the implementation of the eyeball coagulation procedure, there is a small risk associated with the appearance of other localizations, with dystrophic vessels and possible ruptures. Persons who have been diagnosed with diabetes are advised to carefully monitor the health of their eyes after the procedure.

For prevention purposes, it is necessary to visit the ophthalmologist monthly. Preventive control must be carried out for a period of time up to six months. In the future, you can limit yourself to a visit to the ophthalmologist's office up to once a quarter. Prevention of the fundus plays a significant role in identifying new localizations with tissue degeneration of the retinal area, as well as its thinning and rupture. This measure is designed to timely prevent the possible consequences of surgical intervention.

Laser coagulation of the retina improves and preserves vision, improves blood flow, and prevents retinal detachment

Conclusion

Today, in the age of computer technology and constant progress, human organs are especially susceptible to various diseases. So, spending time behind the screens of phones and laptops has a detrimental effect on the visual organs.

Leading representatives of medicine strongly recommend paying more attention to your body. At the slightest suspicion of any pathology in the body, you should immediately seek qualified medical help.

Laser coagulation is the only and most effective method of dealing with numerous pathological changes in the eyeball. But remember that the result you have achieved is not stable. The quality of vision can deteriorate significantly if simple preventive rules and an annual examination by a specialist are neglected.

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20.11.2017

Laser coagulation of the retina(RLS) is a minimally invasive procedure used to seal or destroy the blood vessels in the retina.

It can be used for both preventive and therapeutic purposes. LKS is able to stop degenerative and dystrophic processes in a timely manner. It can prevent retinal tears and destroy abnormal tissue found in the back of the eyeball. Photocoagulation was introduced by Mayer-Schwickerath in the 1950s.

Indications for implementation

The main goal of the technique is to create a strengthening adhesion between the retina and choroid. The laser causes a burn in the amount of 50 to 100 microns in duration within 0.05 - 0.1 seconds.

Laser coagulation appointed:

Diabetic retinopathy. Due to the impact on the newly formed vessels, the prevention of such terrible conditions as hemophthalmia, traction detachment, rubeosis of the iris is carried out;
Retinopathy of prematurity (active phase). The technique stops the germination of venules and arterioles into the vitreous body, blocks the proliferation of connective tissue fibers;
Rhegmatogenous detachment. This method of treatment is effective only with fresh exfoliation;
Formation of new vessels around the optic disc (if they occupy ½ diameter). This increases the risk of multiple hemorrhages in the fundus and a sharp decrease in visual function;
Peripheral dystrophy of the inner shell. Laser coagulation carried out along the periphery stops further detachment;
Benign and malignant tumors.

Possible contraindications

Strengthening is not carried out in the following situations:

High myopia or hypermetropia;
epiretinal gliosis. Epiretinal membranes are vascular cell proliferations on the surface of the retina, predominantly in the macula. Due to their dense structure, the process of passing the laser is disrupted;
Hemorrhages in the fundus are considered a relative contraindication. Photocoagulation can be carried out only after their elimination;
Opacification of the stratum corneum and vitreous body, as well as the lens. Turbid environments do not allow manipulation, as the visualization of pathological areas is reduced.

Training

The main goal of the preparatory stage is to determine the localization of problem areas, diagnose contraindications and identify possible side effects.

Before manipulation, fluorescein angiography is performed to visualize blood flow.

Direct ophthalmoscopy allows you to examine the fundus in detail, diagnose the pathology of the optic disc and the inner membrane. With visimetry, visual acuity is determined. It should be noted that cauterization is not aimed at improving visual dysfunction, but at stopping its further progression.

Biomicroscopy of the eye and ultrasound in B-mode determine the degree of transparency of the cornea, vitreous body and lens.

Based on the results of the examination, a certain surgical tactic is selected. If photocoagulation of a large area is necessary, then it is performed in several stages.

How is the procedure performed

Laser coagulation does not require hospitalization. It is performed on an outpatient basis and under local anesthesia (proparacaine drops). Sometimes subconjunctival, peribulbar or retrobulbar injections of lidocaine are performed. To dilate the pupil, the instillation of drugs from the group of M-anticholinergics is indicated.

The patient is in a sitting position, while his chin is placed on the lower bar of the apparatus, and his forehead rests on its upper part. The operation itself lasts an average of 20-30 minutes. The laser source is connected via fiber optic cable to various types of delivery systems. The beam enters through the cornea (transcorneally) or the sclera (transsclerally). The latest technology provides a point impact, so the risk of complications is minimal, and the effectiveness is predictable. Usually the doctor makes 1500-5000 burns of a typical size during 1-4 sessions.

Sequencing:

A special lens is attached to the cornea to fix the organ. It prevents the occurrence of involuntary movements and the ingress of rays into the eyelid. The patient should look straight ahead during the procedure. As a rule, a wide-angle or reflex lens is used;
The beam is directed to problem areas and in this area causes coagulates. In this case, the patient observes photopsies, which are accompanied by sound;
After the manipulation, the person looks up, the fixing lens is removed, and drops with antiseptics are instilled.

Laser coagulation of the eye has several types: barrier, panretinal, peripheral, local. A full-fledged chorioretinal adhesion is formed in 10-14 days.

State-of-the-art micropulse technology helps the clinician control the timing and intensity of laser pulses to shorten cauterization time and maximize accuracy. These short pulses are applied to the anomalous vessels just milliseconds apart. This technology reduces the likelihood of damage to adjacent epithelium.

Advantages

The positive side of laser coagulation is that it is performed by a non-contact method, on an outpatient basis and under local anesthesia. After the intervention, the person can proceed with their normal activities. The laser creates scar tissue that slows down the growth of new venules and arterioles.

After cauterization, there is an intraocular facilitation of oxygen and nutrient transport, improved excretion of metabolic waste, a reduction in metabolic load, and a decrease in the sequestration of pro-angiogenic cytokines in photoreceptors.

Postoperative period

After surgery, there is often a feeling of mild discomfort and slight soreness. In fact, vision may be hazy or blurry for the first 24 hours. On the second day after applying local adhesions, the patient should visit the clinic. An ophthalmologist evaluates the effectiveness of the minimally invasive treatment. In the postoperative period, fluorescein angiography is indicated to identify loci where additional strengthening is needed.

Complications

The most frequent complications: iritis, hemophthalmos, ischemia of the optic nerve, retinal detachment. If symptoms such as an increase in flashes and floaters, pain, redness, a significant deterioration in visual function, or a feeling that the field of vision is covered by a black curtain, an ophthalmic surgeon should be urgently contacted.

The key to the absence of undesirable consequences is an experienced specialist who strengthens light-refracting media.

Price for laser photocoagulation depends on the level of the medical center. The pricing is influenced by the technical characteristics of the equipment used, the methods of preoperative examination and the types of surgical equipment.

Appointment Signed up today: 15

The recovery period after LKS passes quickly and easily, but it plays an important role in terms of the effectiveness of laser treatment. There are a number of factors that can affect the healing process of the wound surface. This can not only minimize the effectiveness of laser coagulation of the retina, but also lead to the development of various exacerbations.

In connection with the foregoing, it is very important to adhere to all the recommendations of the doctor and seek qualified help in a timely manner when negative phenomena appear.

The course of the postoperative period after

Based on the type of medical institution in which the procedure was performed, the patient can be left in the clinic for a couple of days - or they can go home a couple of hours after the operation. The second option is practiced more often. In such a situation, after complete restoration of visual function (about 2 hours), the doctor conducts a control examination of the fundus under the slit lamp.

The first day after laser exposure, the surgical site swells and turns red. With physical activity, as well as with eye strain, eye and headaches occur. Often, these conditions resolve themselves after 2-3 days, but if the doctor's recommendations are not followed, they can drag on for a longer period.

Complete retinal repair usually takes 2 weeks.

The specified period may increase, depending on the individual characteristics of the patient's body.

Video: Laser coagulation of the retina

Early recovery period after LKS - what is possible, what is not?

Due to the fact that the first few days after the manipulation in question, the patient will be disturbed by pain, he is prescribed painkiller eye drops.

In order to prevent infection of the operating site, they are also used anti-inflammatory topical agents.

To minimize the risk of complications, before the formation of a high-quality adhesion after laser exposure (which takes, on average, 14 days), the following recommendations should be followed:

Do not rub your eyes with your hands and try not to touch them.
Protect yourself from colds: first of all, the wound surface will suffer. In this regard, it is better not to visit social events, as well as places where there are many children.
Do not overstrain your eyes with reading, watching TV, needlework, and driving a vehicle.
Wear sunglasses when you go outside. On the day of the operation, it is better not to go outside, because. There is marked photophobia.
Don't lift anything heavy. Even carrying a 1kg bag can cause eye/head pain. At the end of the rehabilitation period, it is not recommended to lift weights weighing more than 5 kg.
Refuse to engage in sports in which there is a high risk of injury, which provoke vibrations, shaking of the body (running, jumping, etc.). The first day after this procedure, it is better to organize bed rest, and take a vacation at work until full recovery.
Limit the amount of salt, spices, liquids in the diet. The same goes for drinking alcohol and caffeinated drinks. In the aspect of smoking, there are no prohibitions, however, getting smoke into the eyes causes discomfort.
Refusal of decorative cosmetics: mascara, shadows, etc. It is also forbidden to wipe the eyelids with alcohol-containing tonics.
Protect yourself from stressful situations and experiences as much as possible.
Avoid tilting the torso forward (including when washing your hair). Sleep in such a way that the legs are not higher than the head. The first night after laser coagulation is better to sleep on your back.

If the manipulation in question was performed on a person with diabetes should monitor his blood sugar levels.

For those who suffer from regular an increase in blood pressure, you need to control this indicator and take the necessary drugs on time.

Late recovery period after laser coagulation of the retina - prevention of complications and lifestyle

A couple of weeks After laser treatment, the patient must come to an appointment with an ophthalmologist for a follow-up examination.

In the presence of diabetes such visits should be more frequent: monthly for the first 6 months. In the next six months, preventive examinations should be carried out every 3 months, and in the future (in the absence of any exacerbations), the number of visits is reduced to 2 per year. During such appointments, the doctor checks the fundus for thinning of the retina.

With a sharp deterioration in visual abilities, the appearance of "flies" in the eyes, flashes, and other uncomfortable sensations in the area of laser exposure, you need to see a doctor immediately!

Vision correction after laser coagulation of the retina - when can I wear glasses or lenses?

In the absence of any aggravation after the procedure in question, lenses / glasses can be worn already the day after surgery.

If there is discomfort in the area of laser exposure, it is better to use optical devices for vision correction. for 2-3 days.

In the event that the patient has corneal edema, inflammatory processes in the iris, or dark spots appear in the field of view, wearing contact lenses should be postponed until the elimination of these phenomena.

What to do if the eye hurts, other complications arise after laser coagulation of the retina?

In the first days after the procedure under consideration, it is extremely rare, but the following negative conditions may still occur:

Inflammatory phenomena in the conjunctiva zone. This is due to the formation of small wounds during laser exposure, which can become inflamed under the influence of various factors. To prevent this exacerbation, anti-inflammatory drops are prescribed. If infection occurs, antibiotics are used.
in which patients complain of discomfort and burning in the eyes. A similar phenomenon is a consequence of insufficient production of lacrimal fluid. When yawning, the patient feels significant relief. The complication under consideration can be eliminated through the use of special eye drops.
Repeated retinal detachment. It can occur if the underlying ailment has not been established or cured, as well as with extensive initial retinal detachment. In this condition, repeated laser coagulation is required.
Violation of visual functions. It can be provoked by edema in the first days after manipulation. In such a situation, no action should be taken - the situation stabilizes after the swelling subsides. If the field of vision is noticeably narrowed, and flies or dark spots appear before the eyes, you should immediately seek help.

The considered surgical manipulation is highly effective. The laser is practically the only tool that can cope with diseases of the retina.

Indications for laser coagulation

The use of a laser to influence the retina is resorted to in the presence of:

vascular disorders in it;
signs of dystrophy;
angiomatosis, accompanied by the growth of blood vessels;
venous thrombosis affecting the central retinal vein;
detachments;
diabetic retinopathy, leading to changes in the retina of the eye;
tumor processes;
breaks;
various types of glaucoma;
lesions caused by hypertension, hemorrhage;
cataracts, etc.

Advantages of the method

Laser photocoagulation of the retina is preferred not only because of its effectiveness. It has a number of advantages:

minimum time costs;
no need to apply a large number of stitches;
high-temperature exposure, contributing to the bloodless operation;
the success of the intervention in 70% of patients, which is confirmed by studies and is considered a good result.

Laser coagulation in the clinic "Miracle Doctor"

The Department of Ophthalmology at the medical center "Miracle Doctor" is known for the high qualification of practicing doctors. They are the authors of advanced developments on which laser photocoagulation of the retina is based. Laser equipment is characterized by high precision. All medicines and consumables used in the clinic exclude the manifestation of any complications after the treatment.