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Ravi Radhakrishnan, KV Chalam, Vikram S. Brar, Shailesh K. Gupta, Vijay Khetpal, Ravi Keshavamurthy, Sandeep Grover; Evaluation of the Use of Navigated Laser (NAVILAS®) in the Treatment of Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2011;52(14):594.
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To evaluate the safety and efficacy of a novel, non-contact, automated focal laser with integrated fluorescein angiography in treatment of diabetic macular edema.
A retrospective case study was performed involving twelve patients. A full ophthalmic examination was performed including biomicroscopy. Informed consent was obtained from each patient. The NAVILAS system was used to acquire color, infrared, and red-free photography on each patient. Fluorescein angiogram was then performed and a treatment plan was created for each patient using different laser patterns. Topical anesthesia was placed in the fornix of the treated eye. Using a predetermined plan and target assistance, laser is delivered using a frequency doubled Nd:YVO laser under infrared luminance. A contact lens was not used for the delivery of the laser. SD-OCT (Spectralis) images were captured before and after laser on each patient.
Our case series consisted of 12 patients, 7 male and 5 female. The average age of the study patients was 60 years old (range 42-73). The average visual acuity prior to laser therapy was 0.40 logMAR (Snellen 20/40, range 0-1.9 logMAR). Ten patients had received prior treatment for DME which included focal macular laser, anti-VEGF therapy with intravitreal bevacizumab, intravitreal steroids and or pars plana vitrectomy. Five patients were phakic and seven were pseudophakic. Topical anesthesia was sufficient for comfortable use of NAVILAS laser. The average number of laser shots fired was 73 per session (range 6-186). The average central macular thickness on Spectralis OCT prior to treatment was 360 µm. All patients tolerated the procedure well and no complications were noted. There was no notable damage to the lens or intraocular lens implant with use of the NAVILAS laser. There was no evidence of foveal burn or inadvertent delivery of laser to non-targeted areas of retina on any patient.
The NAVILAS laser delivery system provides a laser safety zone to protect the foveal avascular zone and incorporates point to point correlation of surgeon directed laser spots on real time fluorescein angiography and/or color fundus photography, affording the retinal surgeon the ability to safely deliver laser to the retina without the use of a contact lens.
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