.: DERLEME
Retinal Lazer
Retinal Laser
Turkiye Klinikleri J Health Sci. 2019;4(1):51-6
doi: 10.5336/healthsci.2018-59751
Makale Dili: TR
Tam Metin
ÖZET
Argon lazer fotokoagülasyon, diyabetik retinopati tedavisinde 40 yılı aşkın süredir kullanılmaktadır ve intravitreal farmakoterapi çağında bile önemli bir tedavi seçeneğidir. Fakat, single-spot argon lazer fotokoagülasyonun bazı önemli yan etki ve kısıtlılıkları bulunmaktadır. Grid lazer gibi düşük parametrelerin uygulandığı bir işlemden sonra bile lazer skarları genişleyerek retinal hasarı artırmaktadır. Eşik altı "diode micropulse laser" ile lazer maruziyeti mikrosaniyelere düşürülerek retinal hasar azaltılmıştır. Pattern Scan Laser (PASCAL) (Santa Clara, CA, ABD) ile tek oturumda, ağrısız panretinal fotokoagülasyon uygulanabilmektedir. Navilas (OD-OS, Inc, Almanya) ile arka kutup ve periferin eş zamanlı renkli fundus, floresein anjiyografi ve optik koherens tomografi görüntüleri alınabilmekte, görüntüler birbirine entegre edilerek hastaya özel tedavi planı oluşturulmakta ve mevcut bulgu ve tedaviler dijital ortamda kayıt edilebilmektedir. Lazer cihazlarındaki elektroteknik gelişmeler ile lazer sistemleri mükemmelleştirilmiş, yardımcı ekipmanların eklenmesi ile daha hızlı, daha konforlu ve daha güvenli hâle gelmiş ve oftalmolojideki uygulama alanları genişlemiştir. Bu çalışmada; retinal fotokoagülasyonun fiziksel ve biyolojik temelleri, güncel uygulama yöntemleri ve teknolojinin yakın gelecekteki evrimine dair bilgilerin verilmesi amaçlanmıştır.
Anahtar Kelimeler: Retinal fotokoagülasyon; diod lazer; pattern lazer; navigasyonlu lazer
Argon lazer fotokoagülasyon, diyabetik retinopati tedavisinde 40 yılı aşkın süredir kullanılmaktadır ve intravitreal farmakoterapi çağında bile önemli bir tedavi seçeneğidir. Fakat, single-spot argon lazer fotokoagülasyonun bazı önemli yan etki ve kısıtlılıkları bulunmaktadır. Grid lazer gibi düşük parametrelerin uygulandığı bir işlemden sonra bile lazer skarları genişleyerek retinal hasarı artırmaktadır. Eşik altı "diode micropulse laser" ile lazer maruziyeti mikrosaniyelere düşürülerek retinal hasar azaltılmıştır. Pattern Scan Laser (PASCAL) (Santa Clara, CA, ABD) ile tek oturumda, ağrısız panretinal fotokoagülasyon uygulanabilmektedir. Navilas (OD-OS, Inc, Almanya) ile arka kutup ve periferin eş zamanlı renkli fundus, floresein anjiyografi ve optik koherens tomografi görüntüleri alınabilmekte, görüntüler birbirine entegre edilerek hastaya özel tedavi planı oluşturulmakta ve mevcut bulgu ve tedaviler dijital ortamda kayıt edilebilmektedir. Lazer cihazlarındaki elektroteknik gelişmeler ile lazer sistemleri mükemmelleştirilmiş, yardımcı ekipmanların eklenmesi ile daha hızlı, daha konforlu ve daha güvenli hâle gelmiş ve oftalmolojideki uygulama alanları genişlemiştir. Bu çalışmada; retinal fotokoagülasyonun fiziksel ve biyolojik temelleri, güncel uygulama yöntemleri ve teknolojinin yakın gelecekteki evrimine dair bilgilerin verilmesi amaçlanmıştır.
Anahtar Kelimeler: Retinal fotokoagülasyon; diod lazer; pattern lazer; navigasyonlu lazer
ABSTRACT
Argon laser photocoagulation is used for over 40 years in treatment of diabetic retinopathy and is an important treatment option even in the era of intravitreal pharmocotherapy. However, single-spot argon laser photocoagulation has important side effects and limitation. Even after performing laser with a low-parameter such as grid laser, laser scars enlarge and the retinal damage increases. Laser exposure was reduced to microseconds by subthreshold diode micropulse laser and retinal damage was decreased. Pattern Scan Laser (PASCAL) (Santa Clara, CA, USA) provides painless panretinal photocoagulation in a single session. Navilas (OD-OS, Inc, Germany) can simultaneously obtain color fundus photographs of posterior pole and peripheral retina; can capture images of fluorescent angiography, and optical coherence tomography; plan of patient-specific treatment after integration of images; and records current findings or treatments in digital environment. The system has been perfected with the electrotechnical developments in laser devices, it has become faster, more comfortable and safer after the integration of auxiliary equipments, and the fields of application in ophthalmology have expanded. In this study, we aimed to give information about the physical and biological bases of retinal photocoagulation, current application methods and the evoluation of the technology in near future.
Keywords: Retinal photocoagulation; diode laser; pattern laser; navigated laser
Argon laser photocoagulation is used for over 40 years in treatment of diabetic retinopathy and is an important treatment option even in the era of intravitreal pharmocotherapy. However, single-spot argon laser photocoagulation has important side effects and limitation. Even after performing laser with a low-parameter such as grid laser, laser scars enlarge and the retinal damage increases. Laser exposure was reduced to microseconds by subthreshold diode micropulse laser and retinal damage was decreased. Pattern Scan Laser (PASCAL) (Santa Clara, CA, USA) provides painless panretinal photocoagulation in a single session. Navilas (OD-OS, Inc, Germany) can simultaneously obtain color fundus photographs of posterior pole and peripheral retina; can capture images of fluorescent angiography, and optical coherence tomography; plan of patient-specific treatment after integration of images; and records current findings or treatments in digital environment. The system has been perfected with the electrotechnical developments in laser devices, it has become faster, more comfortable and safer after the integration of auxiliary equipments, and the fields of application in ophthalmology have expanded. In this study, we aimed to give information about the physical and biological bases of retinal photocoagulation, current application methods and the evoluation of the technology in near future.
Keywords: Retinal photocoagulation; diode laser; pattern laser; navigated laser
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