Study object: age-related macular degeneration (AMD). Purpose: to improve the treatment efficacy in patients with age-related macular degeneration through the optimization of indirect laser photocoagulation for soft macular drusen based on studying an effect of 577-nm microimpulse laser photocoagulation on structures of the retina and choroid. Methods: electron microscopy of experimental rabbit chorioretinal complex using a PEM-100-01 Transmission Electron Microscope, visual acuity testing, biomicroscopy and ophthalmoscopy using a slit lamp (Reichert-SL255), color fundus imaging, fluorescein angiography using the Topcon TRC-50EX retinal camera, long-wave fundusgraphy, retinal optical coherence tomography (SOCT Copernicus OPTOPOL). Information technology methods and techniques, i.e. statistical processing and analysis. Findings: 532-nm and 577-nm selective retinal laser photocoagulation (RLPC) results in more severe damage, up to destruction, to retinal pigment epithelium (RPE) cells as well as damage to photoreceptor cells without involvement of the nuclear compartment of the cell. 577-nm micropulse RLPC with the power setting adjusted to 50% threshold results in damage mostly to apical aspects of RPE cells and photoreceptor outer segments. Compensatory and restorative processes in the retinal cells lead to restoration of the ultrastructure of the apical aspect of RPE and photoreceptor cells, which was observed at day 14 after 577-nm micropulse RLPC with the power setting adjusted to 50% threshold. Availability of different RLPC modes makes it possible to select the required extent of damage to the structure of the chorioretinal complex. When switching the modes of 577-nm retinal laser photocoagulation with exposure time of 0.1 s, selective damage to the retinal structures was observed. Thus, after micropulse RLPC with the power setting adjusted to 25% threshold, minimal damage to the apical aspect of the RPE cells was observed; after micropulse RLPC with the power setting adjusted to 50% threshold, there was destruction mainly of the apical aspect of the RPE cells and photoreceptor outer segments; after micropulse RLPC with the power setting adjusted to 75% threshold, the RPE cells and PRC demonstrated damage to all cell components, including the nuclear compartment of the cell. 557-nm indirect micropulse RLPC is efficacious in treatment of AMD patients with a wide variation in the extent of structural and functional loss, including patients with drusenoid pigment epithelium detachment. 557-nm indirect micropulse RLPC in patients with AMD results in visual acuity stabilization and improvement in 96.5% of cases and a decrease of drusen height in 93% of cases during the 12-month follow-up. 557-nm indirect micropulse RLPC is safe treatment for patients with AMD. Thus, neither subretinal neovascularization nor geographic atrophy was revealed during the 12-month follow-up. Results of the present study have been introduced into the practice of Laser Department of SI “The Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine”, “Institute of Medical Innovations - Medical Center Oko LLC”, Chernivtsi, Ophthalmology Devision of Surgical Department No 2 in Starobilsk District Territorial Medical Association, Starobilsk, Luhansk Oblast.
