Additional Indications - Case Presentations

µs Treatment in Branch Vein Occlusion

Baseline
A male middle-aged patient presented with severe BRVO. Little to no improvement was achieved despite several anti-VEGF injections. A single µs treatment was attempted to reduce injection burden

Image Courtesy: Dr. Wayne Solley, Texas Retina, Arlington, TX

Navilas Treatment
The treatment plan was outlined as confluent grid covering thickened area (100µm, 100ms). After titration in continuous wave mode (endpoint barely visible burn) and switch to 10% Duty Cycle with the same power as in titration.

Image Courtesy: Dr. Wayne Solley, Texas Retina, Arlington, TX

Outcome
During the 3 month follow up the patient returned with significant reduction of edema and an improved best corrected visual acuity to 20/52-1

Image Courtesy: Dr. Wayne Solley, Texas Retina, Arlington, TX

    µs Treatment in Central Serous Chorioretinopathy

    Baseline
    46 year old male presented with decreased vision (20/25) and thickened foveal area due to non-resolving CSCR.

    Image Courtesy of Dr. Jay Chhablani, LV Prasad Eye Institute.

    Navilas Treatment
    Treatment was performed with a confluent 3x3 grid. Parameters were adjusted to 5%DC, 100µm & 100ms. Titration was done in microsecond mode and power turned down to 30%

    Image Courtesy: Dr. Jay Chhablani, LV Prasad Eye Institute.

    Outcome
    On the 4 month follow patient presented with completly resolved subretinal fluid and improved vision from 20/25 to 20/20.

    Image Courtesy: Dr. Jay Chhablani, LV Prasad Eye Institute.

      Branch Retinal Vein Occlusion (BRVO)

      Baseline
      Patient 60 years, male presented with decreased vision. Color fundus photographs demonstrate extensive retinal hemorrhages and cotton-wool spot formation.Vein obstruction is localized at the arterial venous crossing.

      Diagnosis
      Medical evaluation revealed a short term history of hypertension. Moderate macular edema is also present and documented on central sub-field and superior aspect OCT.

      Navilas Treatment
      A series of individual focal spots and grid patterns were planned on the corresponding FA. A total of 490 laser spots were applied (100µm, average of 97mW, 100ms).

      Outcome
      Six weeks post-operative exam reveals a significantly flattened macula per OCT compared to baseline (upper left). VA improved to 20/20. Photos courtesy of Dr. Ober, Retinal Consultants of Michigan.

        Idiopathic Perifoveal Teleangiectasia

        Baseline
        Patient 56 years, male presented with a vision of 20/32. Clinical ophthalmoscopy revealed a blunt foveal reflex, a small lesion in the macula. Medical evaluation was negative for diabetes or other causes of macular edema.

        Diagnosis
        Fluorescein angiography (FA) demonstrated a macular lesion with a spot of hyperfluorescence adjacent to it.

        Navilas Treatment
        Using a Navilas FA image the treatment was planned to specifically target teleangiectasia and the adjacent area. Navigated treatment was performed using 120µm, 100ms, 100mW.

        Outcome
        Post-treatment representation showing the reduction of the teleangiectasia over the period of 1 (middle) and 3 (bottom)
        months compared to intial (top). Photos courtesy of William R. Freeman, MD;University San Diego La Jolla.

          Diabetic Macular Edema (DME)

          Baseline
          This 65-year-old Asian male with type II diabetes presented with decreased visual acuity of 20/60 in his left eye and 20/80 in his right eye associated with macular edema.

          Diagnosis (1)
          Ocular exam revealed pre-proliferative diabetic retinopathy bilaterally with clinically significant macular edema, intraretinal hemorrhages and cotton-wool spots in both eyes.

          Diagnosis (2)
          Both eyes on Spectral OCT showed significant retinal fluid, the left eye demonstrating more.

          Navilas Treatment
          Bilateral image-stabilized treatments were planned directly on Navilas FA: Subthreshold treatment of perifoveal disease within 500 microns from the foveal center and threshold treatment of all extrafoveal microaneurysms.

          Outcome
          The previous perifoveal swelling in the left eye disappeared. SD-OCT after Navilas showed resolution of macular edema as compared to pre-operative OCT. Three months after treatment the visual acuity improved to 20/20 OU and the patient was symptom-free. Photos courtesy of William R. Freeman, MD; UCSD

            Drainage of Sub-ILM-Hemorrhage into the Vitreous

            Case study by Marcus Kernt M.D., LMU Munich, Germany

            Retinal Tear

            Patient (46 years) presented with a retinal tear at 1’ clock position with traction. Patient was scheduled for immediate laser coagulation.

            Treatment was performed using navigated pattern mode. 108 spots were applied with a mean power of 148mw; 30ms pulse duration and 95µm spot size was applied. The procedure was fast and comfortable for the patient.

            Treatment control 3 days post treatment was performed using Optos Wide field imaging system and revealed full bordering of retinal tear. Spots around tear are well visible.

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