糖尿病黄斑浮腫に対する硝子体手術後の長期視力成績

Long-term visual outcome of vitrectomy for diabetic macular edema

目的：糖尿病黄斑浮腫に対する硝子体手術の長期成績の報告。症例：同一術者が8年間に硝子体手術を行った239例351眼を対象とした。全例がびまん性糖尿病黄斑浮腫で，後部硝子体膜の肥厚と剝離がなかった。324眼（92.3％）に汎網膜光凝固の既往があった。結果：術後の観察期間が5年以上の237眼と5年以内の81眼との間に，術前背景因子と術後最終視力に差がなかった。術後5年以内に死亡した33眼では，年齢，HbA₁c，ヘマトクリット値，腎症，術前視力について，ほか2群の318眼と有意差があった。すべての3群で，術後1年の視力と最終視力に差がなかった。すべての3群で，術後視力が不変または改善した症例は約80％であった。結論：糖尿病黄斑浮腫に対する硝子体手術の長期成績は概して良好であった。

Purpose：To report long-term visual outcome of vitreous surgery for diabetic macular edema. Cases：This retrospective study included 351 eyes of 239 patients who received vitreous surgery by one surgeon during an 8-year period. All the eyes had diffuse diabetic macular edema. Thickening or detachment of posterior hyaloid membrane was consistently absent. Panretinal photocoagulation had been performed on 324 eyes（92.3％）. Results：There was no difference regarding preoperative characteristics or final visual outcome between 237 eyes that could be followed up for 5 years or longer and 81 eyes followed up for less than 5 years. There were significant differences regarding age,HbA₁c,hematocrit,nephropathy,and visual outcome between 33 eyes who died within 5 years of surgery and the other 318 eyes. There was no difference between visual acuity one year after surgery and final visual acuity. Postoperative visual acuity either improved or remained the same in about 80％ in each of three groups. Conclusion：Vitreous surgery was effective for diabetic macular edema regarding long-term visual acuity.