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Treatments and Cases

Contact-free treatment
Contact-free treatment
Microsecond pulsing
Focal OCT-guided treatment
Retinopexy treatment
Speed PRP treatment
Intuitive microsecond pulsing treatment - Software 3.4
Navigated non-contact PRP
Iridotomy treatment
Subthreshold treatment of macular edema
Non-contact retinal tear treatment
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PRP in CRVO 

Baseline PRP in CRVO with Navilas

Baseline

A 54-year-old woman presented to our institute with neovascular glaucoma complicating an ischemic central vein occlusion. Despite legal blindness of the patient in this eye we decided to perform a full scatter PRP in 2-3 sessions.

Individual treatment approach of Dr. Francesca Amoroso, Centre Hospitalier Intercommunal de Créteil, France
Plan PRP in CRVO with Navilas

Treatment

The treatment has been completed in only 2 sessions with 3200 impacts each session. The laser parameters were 20ms, 390µm, spacing 0.5, power 320mW.

Individual treatment approach of Dr. Francesca Amoroso, Centre Hospitalier Intercommunal de Créteil, France
Outcome PRP in CRVO with Navilas

Outcome

The Optos follow-up picture shows the complete panretinal photocoagulation with equidistant spot distribution until the far periphery. After one month follow-up we noted the regression of the rubeosis iridis and stabilization of the IOP. This could be maintained until the 12 months follow-up.

Individual treatment approach of  Dr. Francesca Amoroso, Centre Hospitalier Intercommunal de Créteil, France

    "Thanks to the pre-planning and computer-guided laser delivery, we could perform a complete PRP with equidistant spot distribution until the far periphery."

    Dr. Francesca Amoroso, Centre Hospitalier Intercommunal de Créteil, France

    PRP Retreatment in PDR

    Baseline PRP Retreatment of PDR with Navilas

    Baseline

    A 45-years old patient with proliferative diabetic retinopathy (PDR) is showing severe typical signs of PDR on FA images, e.g. neovascularisation and leakages at the optic nerve head and microaneurysms and microhemorrhages.

    Individual treatment approach of  Dr. Emiliano Di Carlo, Department of Ophthalmology, Staedtisches Klinikum Karlsruhe, Germany
    Plan PRP Retreatment of PDR with Navilas

    Treatment

    Two separate patterns were preplanned, one for each nasal quadrant. Caution zones were set on particularly sensitive areas (macula and optic nerve head). Blood vessels were spared using the Navilas unique eraser function.

    Individual treatment approach of  Dr. Emiliano Di Carlo, Department of Ophthalmology, Staedtisches Klinikum Karlsruhe, Germany
    Outcome PRP Retreatment of PDR with Navilas

    Outcome

    A total of 553 spots were applied in one session using two preplanned grids. The distribution of laser spots and gaps between spots is very uniform. Due to Navilas technique, laser spots are equal in size and without distortion in the far periphery.

    Individual treatment approach of  Dr. Emiliano Di Carlo, Department of Ophthalmology, Staedtisches Klinikum Karlsruhe, Germany

      Subthreshold CSCR Treatment

      Baseline

      A 59 year old female presented in our offices with blurred vision during "a couple of months“ and was diagnosed with an acute episode of Central serous chorioretinopathy. Her BCVA was 20/40. We took an observation period of around two months followed to allow a spontaneous resolution. Due to unchanged size of edema after this observation period the patient was scheduled for microsecond pulsing laser.

      Treatment approach courtesy of Dmitrii Maltsev, MD, Military Medical Academy, Russia

      Treatment

      The microsecond pulsing laser treatment was planned using en face OCT image. We targeted flat RPE elevation in upper part of neuroepithelium detachment and covered it with 98 confluently planned laser spots (100 µm). Treatment parameters were 200 ms, 400 mW and 5% duty cycle.

      Treatment approach courtesy of Dmitrii Maltsev, MD, Military Medical Academy, Russia

      Outcome

      About 2 months after laser treatment the subretinal fluid completely resolved and BCVA increased from 20/40 to 20/25.

      Treatment approach courtesy of Dmitrii Maltsev, MD, Military Medical Academy, Russia

        Subthreshold DME Treatment

        Baseline Subthreshold DME Case

        Baseline

        A 61years-old patient with proliferative diabetic retinopathy is showing a decreased visual acuity of 20/250 and a refractory macular edema, not responding to Anti-VEGF injections.

        Individual treatment approach of   Dr. Emma Tsarukyan, Ophtalmological Center After S.V.Malayan, Yerevan, Armenia
        Planning Subthreshold DME Case

        Treatment

        On basis of an imported external OCT image, a confluent subthreshold pattern over the most thickened area was planned. Caution zones were placed directly on the macula and on the optic nerve head to prevent healthy and sensitive tissue from getting damaged. Titration was performed in continuous wave mode outside of the vessel arcs, microsecond pulses were used with 10% duty cycle, power was doubled after creating a barely visible burn while titrating.

        Individual treatment approach of   Dr. Emma Tsarukyan, Ophtalmological Center After S.V.Malayan, Yerevan, Armenia
        Reporting Subthreshold DME Case

        Reporting

        As microsecond pulses were used in a subthreshold treament manner, burns are not visible on the retina. Therefore, it´s impossible to see the treated areas. Only Navilas unique report function allows a documentation by marking treated areas and showing used parameters.

        Individual treatment approach of   Dr. Emma Tsarukyan, Ophtalmological Center After S.V.Malayan, Yerevan, Armenia
        Outcome Subthreshold DME Case

        Outcome

        Three months after Navilas microsecond pulsing treatment, a significant reduction of DME was shown on OCT macula thickness map and a significantly increased visual acuity from 20/250 up to 20/40 was shown.

        Individual treatment approach of   Dr. Emma Tsarukyan, Ophtalmological Center After S.V.Malayan, Yerevan, Armenia

          Success with Microsecond Pulsing in a Patient with Recurrent CSCR and Subfoveal Leakage

          Dr. Wolf Baseline

          Baseline
          Blue laser autofluorescence (BAF), early phase fluorescence angiography (FA) and indocyanin green angiography (ICGA) images were used to detect the source of subfoveal leakage for a patient with recurrent CSCR. 

          Individual treatment approach courtesy of Dr. Waltraud Wolf, MVZ Prof. Neuhann GmbH, Munich, Germany.
          Dr. Wolf Treatment

          Treatment
          A confluent pattern with microsecond pulses was placed covering the leakage source of the CSCR subfoveal fluid. Caution zones were placed over healthy and sensitive tissue. Titration was performed in continuous wave mode outside of the large vascular arches. 

          Individual treatment approach courtesy of Dr. Waltraud Wolf, MVZ Prof. Neuhann GmbH, Munich, Germany.
          Dr. Wolf Outcome

          Outcome
          After one single Navilas MSP laser therapy, the subfoveal edema resolved completely within a time period of 12 weeks.

          Individual treatment approach courtesy of Dr. Waltraud Wolf, MVZ Prof. Neuhann GmbH, Munich, Germany.

            Treating a Retinal Tear in the Far Periphery without LIO

            Non-LIO treatment of a retinal tear using navigated laser

            Baseline

            A female patient presented with several retinal tears due to lattice degeneration in both eyes (left eye treated before on LIO, right eye schedule for a second visit). Due to significant pain during the treatment of the left eye the patient asked for alternatives to LIO. 

            Individual treatment approach courtesy of Dr. Neesurg Mehta, NYEE, New York, US
            Non-LIO treatment plan of a retinal tear using navigated laser

            Treatment

            All lesions could be visualized with Navilas. The treatment plan had been laid out before the treatment was successfully conducted.

            Individual treatment approach courtesy of Dr. Neesurg Mehta, NYEE, New York, US
            Non-LIO treatment plan of a retinal tear using navigated laser

            Treatment

            All lesions could be visualized with Navilas. The treatment plan had been laid out before the treatment was successfully conducted.

            Individual treatment approach courtesy of Dr. Neesurg Mehta, NYEE, New York, US
            Non-LIO treatment documentation of a retinal tear after using navigated laser

            Outcome

            Despite very far position of retinal tears, lesions could easily be encircled with spots. No switch to LIO was necessary. The patient was compliant during all the procedure and clearly commented on much higher tolerability as compared to the LIO. The patient stated that she is clearly preferring the treatment on Navilas as compared to the LIO. 

            Individual treatment approach courtesy of Dr. Neesurg Mehta, NYEE, New York, US

              "Although we did not feel that the Navilas could provide adequate treatment for laser retinopexy, due to the patient's significant discomfort while using the LIO, we decided to use the Navilas. After the treatment, everyone was surprised as to how quickly it was performed and how comfortable the patient was during the procedure. We now understand why Navilas does not provide an LIO adapter."

              Dr. Neesurg Mehta, New York Eye and Ear Infirmary, USA

              Microsecond Pulsing 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.

              Individual treatment approach courtesy of Dr. Wayne Solley, Texas Retina, Arlington, TX

              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.

              Individual treatment approach courtesy of 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

              Individual treatment approach courtesy of Dr. Wayne Solley, Texas Retina, Arlington, TX

                Microsecond Pulsing 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.

                Individual treatment approach courtesy of Dr. Jay Chhablani, LV Prasad Eye Institute.

                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%.

                Individual treatment approach courtesy of Dr. Jay Chhablani, LV Prasad Eye Institute.

                Outcome

                On the 4 month follow-up, patient presented with completely resolved subretinal fluid and improved vision from 20/25 to 20/20.

                Individual treatment approach courtesy of Dr. Jay Chhablani, LV Prasad Eye Institute.

                  Branch Retinal Vein Occlusion (BRVO)

                  Baseline

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

                  Individual treatment approach courtesy of Dr. Ober, Retinal Consultants of Michigan.

                  Diagnosis

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

                  Individual treatment approach courtesy of Dr. Ober, Retinal Consultants of Michigan.

                  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).

                  Individual treatment approach courtesy of Dr. Ober, Retinal Consultants of Michigan.

                  Outcome

                  Six weeks post-operative exam revealed a significantly flattened macula per OCT compared to baseline (upper left). VA improved to 20/20. 

                  Individual treatment approach 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.

                    Individual treatment approach courtesy of William R. Freeman, MD;University San Diego La Jolla.

                    Diagnosis

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

                    Individual treatment approach courtesy of William R. Freeman, MD;University San Diego La Jolla.

                    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.

                    Individual treatment approach courtesy of William R. Freeman, MD;University San Diego La Jolla.

                    Outcome

                    Post-treatment representation showing the reduction of the teleangiectasia over the period of 1 (middle) and 3 (bottom) months compared to intial (top).

                    Individual treatment approach 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 VA of 20/60 in his left eye and 20/80 in his right eye associated with macular edema. 

                      Individual treatment approach courtesy of William R. Freeman, MD; UCSD

                      Diagnosis (1)

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

                      Individual treatment approach courtesy of William R. Freeman, MD; UCSD

                      Diagnosis (2)

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

                      Individual treatment approach courtesy of William R. Freeman, MD; UCSD

                      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.

                      Individual treatment approach courtesy of William R. Freeman, MD; UCSD

                      Outcome

                      The perifoveal swelling in the left eye disappeared. SD-OCT after Navilas showed resolution of macular edema as compared to pre-operative OCT. 3 months after treatment the VA improved to 20/20 OU and the patient was symptom-free. 

                      Individual treatment approach courtesy of William R. Freeman, MD; UCSD
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