Methods for marking coagulation sites on a retina and systems for coagulation of the retina

Abstract

Method for marking coagulation sites on a retina using a light source comprising the following steps: - Projection of a serial spot sequence from the light source, consisting of a sequential, one-dimensional sequence of individual spots, onto the retina using a beam deflection unit, wherein the individual spots denote the coagulation sites; - Waiting for confirmation of the sequence of individual spots by inputting a confirmation signal; - After confirmation of the sequence of individual spots, recalculation of an automated step sequence with another serial spot sequence and projection of the same onto the retina according to the first step; - Subsequent repetitions of the second and third steps; - wherein an automated step sequence specifies an equidistant translation.

Description

The invention relates to a method for marking coagulation sites on a retina using a light source and to a system for coagulating the retina to carry out such a method. From WO 2008 / 112236 A1, an optical scanning system for performing treatment on the trabecular meshwork of the eye and a corresponding method are known. In this system, a pattern is generated by a light beam using a scanning device. The pattern is projected onto the trabecular meshwork by means of mirrors. The treatment of the trabecular meshwork then takes place at the points defined by the pattern. German patent DE 101 35 944 A1 discloses a method and a device for non-invasive temperature determination in the fundus of the eye treated with laser radiation. During the irradiation period, additional radiation pulses of short duration and low energy are directed at the treated tissue at regular intervals. The resulting tissue expansions are detected by optical or pressure measurement, and the absolute temperature values ​​are determined from the measurement signals. If necessary, the treatment radiation is controlled accordingly. A system for laser treatment of the retina is known from WO 2005 / 065116 A2. In this system, a pattern of treatment areas is generated on the retina by a laser source in response to an operator action. The pattern is created by a scanner that moves the laser beam. Additionally, an alignment beam in the visible spectrum is also present, which is moved by the scanner to the specified locations in the pattern. The use of focused light from an axial high-pressure lamp to treat various retinal diseases, such as diabetic retinopathy, using light coagulation has been known for decades. In modern light coagulation, a laser beam is used to heat and coagulate the retina. The energy of the laser beam is absorbed by the dark pigment in the retinal pigment epithelium. This focuses metabolic activity on the still-healthy areas of the retina. Furthermore, biochemical cofactors are stimulated. The progression of the disease is thus significantly slowed or halted. A problem with this method, however, is that valuable tissue, particularly the photoreceptor layer located in front of the retinal pigment epithelium in the direction of the laser beam, is also destroyed. Therefore, solutions have been devised to minimize the destruction of this valuable tissue by terminating the local treatment when a defined temperature is reached at the coagulation point. This is achieved using a temperature-controlled coagulation system with a continuous coagulation laser, a pulsed measuring laser, a detector, a control unit, and an interrupter. The coagulation laser is configured to emit a coagulation beam, and the measuring laser generates a temperature-dependent measurement signal for the detector within the target area of ​​the coagulation laser. The detector incorporates a temperature sensor that detects a signal allowing conclusions to be drawn about the temperature at the coagulation point.The signal detected by the detector is forwarded to the control unit, which activates the interrupter when a predetermined temperature is reached, thus interrupting the beam of the coagulation laser. The individual coagulation points are regularly set up manually by the operator, who then triggers the coagulation jet individually. Since this is very time-consuming and the success of the treatment depends heavily on the operator's skill, WO 2007 / 035855 A2, for example, proposed a system and procedure that provides a pattern of coagulation points from which the operator can pre-select and combine different patterns. Patterns are defined as two-dimensional arrangements of coagulation points, such as a matrix of 2 x 2, 3 x 3, 4 x 4, 5 x 5, etc., where the distances between adjacent coagulation points are constant. This prior art also provides other two-dimensional patterns for coagulation points, such as arrangements on a circle or...on concentric circles, elliptical and sector-shaped arrangements. However, such fixed patterns of regular geometry are disadvantageous because they often do not correspond to the morphological characteristics of physiological anomalies. Therefore, post-coagulation with a second or third coagulation pattern, even to the point of single-shot coagulation that such a procedure is actually intended to overcome, is frequently necessary to achieve fully effective panretinal photocoagulation. Furthermore, while the aforementioned state of the art allows for the creation of a large-area pattern, leading to an increase in treatment speed, it also carries the risk of over- or under-coagulation due to the changing focus caused by retinal curvature or varying absorption characteristics of the ocular media. The object of the invention is therefore to enable laser treatment, preferably retinal coagulation or laser trabeculoplasty, and particularly preferably optimized panretinal photocoagulation, at the highest possible treatment speed, in which only pathological areas are coagulated, while healthy areas are not. For this purpose, the marking of coagulation sites should be ensured by a method that is visible to the operator before treatment, and a coagulation system with which such marking can be carried out should be provided. This problem is solved by a method for marking coagulation sites on a retina using a light source with the features of claim 1. In this method, a serial spot sequence from the light source, consisting of a sequential, one-dimensional sequence of individual spots, is projected onto the retina by means of a beam deflection unit, wherein the individual spots designate the coagulation sites. This indicates to the operator in advance, i.e., before the actual coagulation takes place, where coagulation should occur. By awaiting confirmation of the sequence of these individual spots, which is achieved by inputting a confirmation signal, it is prevented that coagulation sites should be avoided, for example, because they involve healthy tissue.According to the invention, after confirmation of the sequence of individual spots, an automated step sequence is recalculated with a further serial spot sequence and projected onto the retina. By using a sequential, one-dimensional sequence of individual spots that are automatically generated, a significant increase in speed is achieved compared to manually determining these individual spots by the operator. In contrast to the very complex two-dimensional and large-area pattern provision, the method according to the invention has the advantage that confirmation by the operator is required for each individual sequential, one-dimensional sequence in order to subsequently perform coagulation at these points – which is not part of the method according to the invention.This prevents healthy tissue from being coagulated and ensures that only those coagulation points actually necessary for the healing process are accepted. By repeating the aforementioned steps according to the invention, it is possible to mark a large area of ​​the retina with coagulation points in a short time. An advantageous embodiment of the invention provides that the sequential, one-dimensional arrangement of individual spots has equidistant intervals, the course of which is straight or curved and continuous or interrupted. The various possible placements of the individual spots allow for consideration of the pathological areas of the retina as well as the existing ocular media, such as astigmatism or other refractive errors of the eye to be treated. A further advantageous embodiment of the invention provides that the temporal sequence of the spot sequence lies between 1 ns and 5 s, preferably between 1 µs and 1 s, and particularly preferably between 40 ms and 0.5 s. The aforementioned upper and lower temporal limits are advantageous to ensure rapid execution of the process while simultaneously allowing for good monitoring by the operator. According to the invention, an automated sequence of steps defines an equidistant translation. This allows for the generation of a multitude of patterns derived from a very simple basic pattern, namely the sequential, one-dimensional sequence. This also makes it possible to take into account the individual characteristics of the retina being treated. A further advantageous embodiment of the invention provides that the light source emits laser light, particularly in the red range. The use of laser light in the red range has the advantage that it results in individual spots that can be easily detected on the retina by the operator. A further advantageous embodiment of the invention provides that the operator can actively influence the next spot sequence by varying one or more laser parameters before the confirmation. This allows for optimal setting of the required parameters in the shortest possible time, without the operator having to wait for the system to display the required spot sequence. A further advantageous embodiment of the invention provides that confirmation is effected by means of a joystick, speech recognition, or a foot switch, in particular a multimodal foot switch. Using this device, the operator can provide simple and precise input to confirm the sequence of individual spots proposed by the system. A further advantageous embodiment of the invention provides that confirmation only occurs after the positions of the newly calculated spot sequence have been changed. This allows for particularly good adaptation to the individual characteristics of the retina being treated, since individual sequences of single spots proposed by the system can be rejected, so that coagulation does not occur at the unwanted locations, but only at newly calculated single spots that meet the requirements for desired coagulation. A further advantageous embodiment of the invention provides that the distance between the next spot sequence and the previous spot sequence is between zero and ten times the spot diameter, particularly preferably between 0.8 and 1.5 times the spot diameter of the first individual spot of the previous spot sequence. This allows for a variation ranging from an overlap of the spots—i.e., an increase in the spot area—to a distance that leaves sufficient space between the individual spots. This enables effective individualized treatment of the retina. A further advantageous embodiment of the invention provides that changes to the starting position spacing, orientation, length, inner-sequence spacing, spot sequence type, rotation, translation, and / or step length of the spot sequence relative to the preceding spot sequence are performed by an operator and / or based on previously acquired retinal examination data. This comprehensive ability to modify the individual spots—both in their individual configuration and their spatial arrangement relative to one another—enables optimal treatment precisely where needed.Because the specific determination and definition of the aforementioned spot sequence characteristics is possible based on previously acquired retinal examination data, fully automated coagulation, tailored to the retina being treated, can be performed automatically only at the actually necessary locations. The term "inner-sequence distance" refers to the fact that the distance between two adjacent individual spots within the sequence is not constant, but rather varies from spot to spot. A further advantageous embodiment of the invention provides for the temperature of each individual spot to be determined during the application of a therapeutic beam. This ensures that only a short-term coagulation of the retinal pigment epithelium is achieved, without damaging the overlying photoreceptor layer. Preferably, the therapeutic beam is switched off when a predetermined temperature is reached, which is, in particular, the same for all individual spots. A further advantageous embodiment of the invention provides that the individual spots outline the coagulation sites. This allows the operator to see precisely what the treatment area to be coagulated by the therapeutic beam looks like and whether coagulation should actually take place over the entire area. The problem is also solved by a system for retinal coagulation to carry out a method described above, comprising the features of claim 11. Using the imaging diagnostic unit, the operator can identify the specific location on the retina where coagulation is to be performed before the procedure begins, as the spot sequences marked by the pilot beam can be viewed. The therapeutic beam serves to coagulate the coagulation sites that were previously marked with the pilot beam. Both the therapeutic beam and the pilot beam are controlled by a beam deflection unit such that the spot sequences of the pilot beam are projected onto the retina, and after release by confirmation signal, the therapeutic beam performs coagulation at the marked individual spots.The entire procedure is controlled by an electronic control unit, which specifically controls the triggering of the therapeutic beam and the beam deflection within the beam deflection unit. This is all done via a software interface. Confirmation via the interactive interface is provided by a confirmation signal, which is necessary to trigger the therapeutic beam after the pilot beam has indicated the marking of the individual coagulation sites to the operator. The preferred imaging diagnostic unit is a laser slit lamp, a fundus camera, or a scanning laser ophthalmoscope. A variety of light sources are suitable as therapeutic beams, such as LEDs, superluminescent diodes, gas discharge lamps, and especially lasers. A multi-wavelength laser capable of emitting various colors in the visible range is preferred. Green, yellow, and red are particularly preferred colors. Furthermore, it is also preferred if the multi-wavelength laser emits in the near-infrared range. The different wavelengths allow for varying coagulation depths. The highest absorption by the photopigment melanin occurs in the green wavelength range (514–550 nm); the highest absorption by the blood pigment hemoglobin is achieved in the yellow spectral range (550–580 nm); conversely, coagulation at high penetration depths is achieved using red wavelengths (630–690 nm) or a wavelength in the near-infrared range (e.g., 810 nm). A further advantageous embodiment of the invention provides that the pilot beam is a laser diode, preferably emitting in the red range. The resulting markings on the retina are – as already explained above – easily visible to the operator. A further advantageous embodiment of the invention provides that the beam deflection unit projects the pilot beam and the therapy beam coaxially onto the retina. This ensures that coagulation by means of the therapy beam takes place precisely at the position that was previously indicated to the operator by the pilot beam and which the operator has approved by means of a confirmation signal. This prevents the retina from being coagulated in areas where this should not occur, for example, where intact tissue is still present. A further advantageous embodiment of the invention provides that the beam deflection unit comprises movable lenses, mirrors, or diffractive beam splitters in the beam path. These are well-known, reliable devices for beam deflection in the prior art. Preferably, the lenses or mirrors are controlled by motors; in particular, these are galvanometrically driven mirrors, piezo scanners, or micromirror arrays. A further advantageous embodiment of the invention provides that the control unit is a microcontroller with at least one input and one output interface, and which is programmable. This makes it possible to input pre-determined values ​​about the retina to be treated and the existing ocular media into the control unit, so that it knows the data required for the current treatment and can thus adjust the respective sequence of individual spots to the specific circumstances. This eliminates the need for the operator to regularly refuse to approve the displayed sequence of individual spots and for the system to calculate and display an alternative sequence. Instead, the operator will be able to approve any of the displayed sequences, leading to faster treatment and increased treatment reliability. A further advantageous embodiment of the invention provides for the additional inclusion of an interrupter that prevents at least a specific wavelength range of the therapeutic beam from reaching the coagulation site. As explained above, the penetration depth of the therapeutic beam, and thus the coagulation, can be controlled by using different wavelengths. The interrupter therefore serves to define different penetration depths of the therapeutic beam at a predetermined single spot or at a sequence of single spots. Preferably, the interrupter can be a filter that can be inserted into the therapeutic beam. A further advantageous embodiment of the invention provides that the interrupter is a device that switches off the therapeutic jet, in particular in the form of an aperture in the area through which the therapeutic jet passes. This allows coagulation to be stopped completely and not only selectively at one or more depths, as is the case with the filter described above. A further advantageous embodiment of the invention provides that it additionally includes a temperature measuring device for determining the temperature of the coagulation site while the therapeutic beam is directed at it. As already explained above, this prevents damage to the photoreceptor layer located above the pigment epithelium being treated. Preferably, the temperature is determined by means of a detector within the temperature measuring device that detects pressure waves originating from the coagulation site. Because the temperature measuring device is connected to the interrupter, the therapeutic beam can be switched off immediately upon reaching the predetermined temperature, thus achieving the effect described above of preventing damage to the photoreceptor layer.In addition to a direct connection between the temperature measuring device and the interrupter, an indirect connection via the control unit can also be provided. A further advantageous embodiment of the invention provides that the system is prepared to irradiate each individual spot of the serial spot sequence with the therapeutic beam, using a specific size, shape, wavelength, and duration. This allows for individual treatment of each area of ​​the retina. The size and shape of the treatment area can be precisely adjusted to the required size and shape at each location. The wavelength setting allows for a specific depth of coagulation within the retina, as described above. Thus, depth-modulated laser coagulation is possible across all coagulation sites. By adjusting the duration, the temperature of the individual coagulation sites can be varied, thereby influencing the degree of retinal coagulation. This enables coagulation-degree-modulated laser coagulation across all coagulation sites.The size of the individual spots can be varied over a wide range; preferably, the diameters are in the range of 50–1000 µm. The size of the individual spots can be modulated within a sequence of individual spots (which can be configured as a straight line) or by changing the size of the individual spots from line to line. In addition to achieving the most homogeneous laser therapy possible for the retina with a predetermined equidistant grid, a predetermined uniform temperature, and a predetermined uniform treatment depth due to the wavelength used, a system according to the invention, which comprises a monochromatic or polychromatic laser system, an ophthalmological scanning system, and a temperature measurement system, also enables multidimensional modulation of the treatment intensity of the retina. This allows, for example, the same therapeutic benefit to be achieved for the patient without having to completely coagulate excessively large areas of the retina and thus losing vision. At the same time, retinal detachment and thus a worsening of the disease course are avoided. This is made possible, for example, by placing classic coagulation spots in a coarse grid and working subcoagulably in the spaces between them without damaging the photoreceptors. This method can be used both row by row and within a pattern. Selective retinal therapy can be performed using microsecond laser pulses. This method utilizes the selective absorption of the laser light, particularly green light, within the retinal pigment epithelium. The time-limited exposure in the microsecond range ensures that, during the thermal relaxation period, almost all the heat remains within the selectively absorbing pigment epithelium and does not reach the photoreceptor layer. This stimulates the damaged pigment epithelium to regenerate without leaving visible marks on the fundus image. Another selective retinal therapy is performed over a large area using a scanned CW laser beam. The exposure time is limited by the scan speed, within the thermal relaxation time. In controlled selective retinal coagulation, different absorption properties in the retinal pigment epithelium and different local transmission rates of the ocular media are taken into account. This allows for the treatment of locally varying areas of damage to the retinal pigment epithelium. For example, an optoacoustic or optical temperature measurement system is used. By selecting a wavelength in the yellow, green, red, or infrared spectral range, a homogeneous coagulation or hyperthermia depth can be set. The homogeneity within the area can be structured by selecting equidistant individual spot spacings and their diameters. Treatment can be specifically planned to achieve the best possible patient-specific therapy based on previously collected diagnostic data. Such data is obtained particularly from fundus images (color images, angiographic images, autofluorescence images, etc.), OCT images (optical coherence tomography), or confocal scans. Treatment is then carried out using semi- or fully automated generation of treatment parameters and a semi- or fully automated treatment process. Examples of lasers used include: argon lasers, diode lasers, diode-pumped solid-state lasers, diode-pumped semiconductor lasers, fiber lasers, and frequency-doubled Nd:YAG lasers. These lasers can be used in both pulsed and continuous-wave (CW) modes. The programmed control unit is preferably designed as a hardwired or programmable logic controller. The controller preferably has a process architecture. The focused laser beam is positioned automatically or semi-automatically using deflection elements that can deflect the beam two-dimensionally. This is achieved, for example, by galvanometric mirror scanners, piezoelectric optical elements, acousto-optic elements, electro-optic elements, or laterally moving lenses. The beam positioning elements can move the beam translationally, torsionally, tilted, or rotated. These elements can be either reflective or refracting in transmission. The therapeutic beam is either parallel or focused. It may exhibit, for example, an elliptical, or preferably circular, polarization. However, it is equally possible to use linearly polarized or even unpolarized therapeutic beams. Further details of the invention are described below with reference to the accompanying figures. These show: Fig. 1 a sequence of patterns of single spots generated by translation, Fig. 2 a sequence of patterns of single spots generated by rotation, Fig. 3 a sequence of patterns of single spots generated by translation and a change in the initial position, as well as the omission of a spot sequence, Fig. 4 two patterns of single spots generated by translation and a change in the sequence length, Fig. 5 a pattern of single spots generated by translation, a change in the starting point, and the sequence length, Fig. 6 a pattern of coagulation sites generated by lateral change, a change in size, a change in the sequence length, and the inner-sequence spacing, Fig. 7 a sequence of coagulation sites coagulated with different wavelengths, Fig.8 a sequence of coagulation sites that are coagulated by different temperatures. In Fig. 1, the first representation from the left shows the basic form of a sequential, one-dimensional sequence of individual spots, which then serves as the starting point for the further representations of Fig. 1 and their multiple applications - as described below. The sequence consists of eight individual spots, arranged equidistant from each other and running vertically. The first spot is the one shown at the top. From this point, the sequence is generated continuously downwards in the order shown. Starting from this basic form, the pattern shown in the middle figure, consisting of individual spots arranged equidistantly in a 7 x 8 matrix, is obtained by translating the basic vertical sequence of the left-hand representation. The right-hand representation is achieved from the basic representation through further horizontal, multiple translations. In the left-hand illustration of Fig. 2, a shortened initial sequence comprising four individual spots is shown, compared to the eight individual spots in Fig. 1. The pattern shown in the second illustration from the left is obtained from the initial sequence shown in the left-hand illustration by progressively rotating the sequence from left to right around a rotation center (not shown), with alternating sequence lengths of three and four individual spots. The sequences with three individual spots are staggered with the sequences containing four individual spots. This is achieved by simultaneously translating the initial individual spot in an oblique direction. In the second view from the right in Fig. 2, a pure rotation is shown between the first sequence of individual spots, which runs vertically, and the second sequence, which is thereby rotated slightly counterclockwise. The initial sequence—like that in Fig. 1—also has eight individual spots, but the distance between the fourth and fifth spots is significantly increased. This distance is chosen so that no individual spots are present within a circle shown. The center of rotation is simultaneously the center of the circle shown. With a continuous and repeated rotation by the same angle of rotation, indicated in the second view from the right in Fig. 2, the radial view on the right of Fig. 2 is obtained. In the left and middle illustrations of Fig. 3, an irregular translation (which can also be described as a modification of the initial position) is performed. In the left illustration, there is a vertical initial sequence of five individual spots. The middle illustration shows a vertical initial sequence of six individual spots, which - comparable to the two right-hand illustrations of Fig. 2 - have an increased distance between the upper half and the lower half (inner sequence distance) of each set of three individual spots. In contrast, in the right-hand representation of Fig. 3, a vertical sequence of seven individual spots is supplemented by a uniform translation to form a pattern, which, however, is changed with regard to the shape of the individual spots between the first and second (as well as the fifth and sixth) sequences compared to the third and fourth (as well as seventh) sequences in that the latter spot positions can be omitted by the operator, i.e., do not represent coagulations. In the two illustrations of Fig. 4, translations and changes in sequence length are superimposed, with vertical mid-symmetry of the spot sequence. In the right-hand illustration, this results in a pattern that represents a triangle with decreasing sequence length from left to right. Finally, Fig. 5 shows a pattern that is irregularly formed and is achieved by varying the sequence length, translation and changing the starting locations through the initial sequence of four vertical single spots shown on the far left. The patterns shown in Figures 1, 2, 3, 4 to 5 are merely examples and can be modified in any way to create any desired pattern. This makes it possible to precisely address the individual case requiring treatment and to position the pattern so that coagulation occurs only at the necessary coagulation points. The individual spots shown in Figures 1, 2, 3, 4 to 5 are created by the pilot beam, and the therapeutic beam then performs the coagulation at these points. Figure 6 shows a pattern starting from a horizontal sequence of individual spots, in which the top row has been modified by altering both the sequence length and the inter-sequence spacing. These are not the points marked by the pilot beam, but rather the coagulation points subsequently created with the therapeutic beam. The diameter of these coagulation points varies depending on the required size for each individual case. Preferably, the diameters of such coagulation points are between 50 and 500 µm. Between the lowest and second-lowest (and subsequently also between the second-lowest and second-highest) sequences of individual spots, a change in the diameter of each spot was implemented along with the vertical translation. Between the second sequence from the top and the topmost sequence, however, not only was the diameter of the individual spots partially changed (namely, every second individual spot was reduced from the size of the second sequence from the top to a size corresponding to the second sequence from the bottom), but the sequence was also lengthened from four to seven individual spots, and the spacing between the spots within the sequence was also altered. Figure 7 shows a grid of coagulation points with the same diameter, irradiated with different wavelengths. A wavelength of 577 nm was used for yellow light (550–580 nm), 532 nm for green light (514–550 nm), and 659 nm for red light (630–680 nm). The sequence from left to right is: yellow, green, red, green, yellow, green, red. Due to the different wavelengths used, the main energy absorption in the retina occurs at different depths. For example, coagulation occurs in the upper region of the retina because of the highest absorption by the blood pigment hemoglobin in the yellow spectral range. In contrast, the highest absorption in the green wavelength range is due to the photopigment melanin, and coagulation occurs in the middle depth of the retina. Finally, red wavelengths penetrate the retina to the deepest depths, resulting in the highest degree of coagulation there. By selectively irradiating different coagulation sites with different wavelengths (colors), depth modulation can be achieved. This allows the individually required treatment to be tailored to the patient. Figure 8 shows the same grid of coagulation sites as Figure 7. However, in Figure 8, modulation is not performed with different wavelengths of light, but rather with different coagulation temperatures. The coagulation here occurs monochromatically at a wavelength of, for example, 532 nm (i.e., in the green wavelength range). Due to the different coagulation temperatures of, for example, 45°, 50°, and 60°, different degrees of coagulation are achieved within the depicted coagulation sites. The length of the arrows illustrates the degree of coagulation in the retina, with longer arrows representing a higher degree of coagulation than shorter ones. This results in equidistant, monochromatic, coagulation-degree-modulated laser coagulation or hyperthermia.

Claims

Method for marking coagulation sites on a retina using a light source comprising the following steps: - Projection of a serial spot sequence from the light source, consisting of a sequential, one-dimensional sequence of individual spots, onto the retina using a beam deflection unit, wherein the individual spots denote the coagulation sites; - Waiting for confirmation of the sequence of individual spots by inputting a confirmation signal; - After confirmation of the sequence of individual spots, recalculation of an automated step sequence with another serial spot sequence and projection of the same onto the retina according to the first step; - Subsequent repetitions of the second and third steps; - wherein an automated step sequence specifies an equidistant translation. Method according to claim 1, characterized in that the sequential, one-dimensional sequence of individual spots has equidistant distances, the course of which is straight or curved and continuous or interrupted. Method according to claim 1 or 2, characterized in that the temporal sequence of the spot sequence is between 1 ns and 5s, preferably between 1 ns and 1s, particularly preferably between 40 ms and 0.5 s. Method according to one of the preceding claims, characterized in that the light source emits laser light, in particular in the red range. Method according to one of the preceding claims, characterized in that the operator actively influences the process by varying one or more laser parameters before confirming the next spot sequence. Method according to one of the preceding claims, characterized in that confirmation is effected by means of a joystick, speech recognition or a foot switch, in particular a multimodal foot switch. Method according to one of the preceding claims, characterized in that the confirmation only takes place after the positions of the recalculated spot sequence have been changed. Method according to one of the preceding claims, characterized in that the distance of the next spot sequence from the previous spot sequence is between zero and ten times, particularly preferably between 0.8 and 1.5 times, the spot diameter of the first single spot of the previous spot sequence. Method according to one of the preceding claims, characterized in that a change in the distance of the starting position, the orientation, the length, the inner sequence distance, the type of spot sequence, the rotation, the translation and / or the step length of the spot sequence relative to the previous spot sequence is carried out by an operator and / or based on previously obtained examination data of the retina. Method according to one of the preceding claims, characterized in that the individual spots surround the coagulation sites. System for retinal coagulation for carrying out a method according to one of the preceding claims comprising: an imaging diagnostic unit, a therapy beam for coagulation of coagulation sites, a pilot beam for marking the coagulation sites by means of a spot sequence, a beam deflection unit for generating the spot sequence and for positioning the therapy beam, an electronic control unit for controlling the aforementioned devices, which is designed such that further serial spot sequences can be calculated by an automated step sequence that specifies an equidistant translation, a software interface and an interactive interface. System according to claim 11, characterized in that the imaging diagnostic unit is a laser slit lamp, a fundus camera or a scanning laser ophthalmoscope. System according to claim 11 or 12, characterized in that the therapy beam comes from the group of the following light sources: LEDs, superluminescent diodes, gas discharge lamps, lasers. System according to claim 13, characterized in that the laser is a multi-wavelength laser in the visible range, in particular with the colors green, yellow and red, and / or in the near-infrared range. System according to one of claims 11 to 14, characterized in that the pilot beam is a laser diode which preferably emits in the red range. System according to one of claims 11 to 15, characterized in that the beam deflection unit images the pilot beam and the therapy beam coaxially onto the retina. System according to one of claims 11 to 16, characterized in that the beam deflection unit has movable lenses, mirrors or diffractive beam splitters in the beam path. System according to claim 17, characterized in that the lenses or mirrors are controlled by motors, in particular galvanometrically driven mirrors, piezo scanners or micromirror arrays. System according to one of claims 11 to 18, characterized in that the control unit is a microcontroller having at least one input and one output interface and being programmable. System according to one of claims 11 to 19, characterized in that an additional interrupter is provided which prevents at least a certain wavelength range of the therapy beam from striking the coagulation site. System according to claim 20, characterized in that the interrupter is a filter that can be inserted into the therapy beam. System according to claim 20, characterized in that the interrupter is a device that switches off the therapy beam, in particular in the form of an aperture in the area through which the therapy beam passes. System according to one of claims 11 to 22, characterized in that it additionally has a temperature determination device for determining the temperature of the coagulation site while the therapeutic jet is directed towards it. System according to claim 23, characterized in that the temperature determination device has a detector that detects pressure waves originating from the coagulation site. System according to one of claims 22 to 24, characterized in that the temperature determination device is connected to the interrupter, also indirectly via the control unit. System according to one of claims 11 to 25, characterized in that it is prepared to irradiate each individual spot of the serial spot sequence with an individual size, shape, wavelength and duration by the therapy beam.

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