Jacobs Retina Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California 92037, USA.
Ophthalmology. 2011 Jun;118(6):1119-24. doi: 10.1016/j.ophtha.2010.10.007. Epub 2011 Jan 26.
To evaluate the clinical use and accuracy of a new retinal navigating laser technology that integrates a scanning slit fundus camera system with fluorescein angiography (FA), color, red-free, and infrared imaging capabilities with a computer steerable therapeutic 532-nm laser.
Interventional case series.
Eighty-six eyes of 61 patients with diabetic retinopathy and macular edema treated by NAVILAS.
The imaging included digital color fundus photographs and FA. The planning included graphically marking future treatment sites (microaneurysms for single-spot focal treatment and areas of diffuse leakage for grid pattern photocoagulation) on the acquired images. The preplanned treatment was visible and overlaid on the live fundus image during the actual photocoagulation. The NAVILAS automatically advances the aiming beam location from one planned treatment site to the next after each photocoagulation spot until all sites are treated. Aiming beam stabilization compensated for patient's eye movements. The pretreatment FA with the treatment plan was overlaid on top of the posttreatment color fundus images with the actual laser burns. This allowed treatment accuracy to be calculated. Independent observers evaluated the images to determine if the retinal opacification after treatment overlapped the targeted microaneurysm.
Safety and accuracy of laser photocoagulation.
The images were of very good quality compared with standard fundus cameras, allowing careful delineation of target areas on FA. Toggling from infrared, to monochromatic, to color view allowed evaluation and adjustment of burn intensity during treatment. There were no complications during or after photocoagulation treatment. An analysis of accuracy of 400 random focal targeted spots found that the NAVILAS achieved a microaneurysm hit rate of 92% when the placement of the treatment circle was centered by the operating surgeon on the microaneurysm. The accuracy for the control group analyzing 100 focal spots was significantly lower at 72% (P<0.01).
Laser photocoagulation using the NAVILAS system is safe and achieves a higher rate of accuracy in photocoagulation treatments of diabetic retinopathy lesions than standard manual-technique laser treatment. Precise manual preplanning and positioning of the treatment sites by the surgeon is possible, allowing accurate and predictable photocoagulation of these lesions.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
评估一种新的视网膜导航激光技术的临床应用和准确性，该技术将扫描狭缝眼底相机系统与荧光素血管造影（FA）、彩色、无赤光和红外成像功能与计算机可控制的 532nm 激光相结合。
介入性病例系列。
61 例糖尿病性视网膜病变和黄斑水肿患者的 86 只眼接受 NAVILAS 治疗。
成像包括数字彩色眼底照片和 FA。规划包括在获取的图像上图形标记未来的治疗部位（用于单点焦点治疗的微动脉瘤和用于网格模式光凝的弥漫性渗漏区域）。在实际光凝过程中，预规划的治疗可见并叠加在实时眼底图像上。NAVILAS 在每次光凝点后自动将瞄准光束位置从一个计划的治疗部位推进到下一个部位，直到所有部位都得到治疗。瞄准光束稳定补偿了患者的眼球运动。预处理 FA 与治疗计划叠加在治疗后的彩色眼底图像上，显示实际激光烧伤。这使得可以计算治疗的准确性。独立观察者评估图像，以确定治疗后的视网膜混浊是否与目标微动脉瘤重叠。
激光光凝的安全性和准确性。
与标准眼底相机相比，图像质量非常好，允许在 FA 上仔细划定目标区域。从红外切换到单色，再到彩色视图，允许在治疗过程中评估和调整烧伤强度。在光凝治疗过程中和之后没有并发症。对 400 个随机焦点靶向点的准确性分析发现，当手术医生将治疗圈的位置中心化在微动脉瘤上时，NAVILAS 实现了 92%的微动脉瘤命中率。对照组分析 100 个焦点的准确性明显较低，为 72%（P<0.01）。
使用 NAVILAS 系统进行激光光凝是安全的，并且在糖尿病性视网膜病变病变的激光治疗中比标准手动技术激光治疗具有更高的准确性。手术医生可以精确地手动预先规划和定位治疗部位，从而实现这些病变的精确和可预测的光凝。
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