糖尿病網膜症における硝子体手術後の血管再灌流

Retinal reperfusion following vitreous surgery for diabetic retinopathy

目的：硝子体手術を行った糖尿病網膜症眼底の無灌流領域での再灌流の検索。対象と方法：硝子体手術を行った糖尿病網膜症48眼と，その僚眼25眼を対象とした。男性26名，女性14名で，年齢は29～81歳，平均63歳であった。術後の経過観察は3～12か月，平均6.7か月であった。手術施行時の網膜症は増殖29眼，非増殖19眼で，眼内光凝固を13眼に併用した。術前と術後の蛍光眼底造影所見から，網膜耳側縫線付近での無灌流領域の再灌流を検索した。結果：手術眼での再灌流は僚眼よりも有意に多く起こった。手術時の年齢が65歳未満，HbA₁c値が7％未満のとき，再灌流が多かった。結論：糖尿病網膜症眼での無灌流領域の再灌流は，硝子体手術を行った後に起こりやすく，患者の年齢とHbA₁c値が関与する。

Purpose：To report the incidence of retinal reperfusion following vitreous surgery for diabetic retinopathy. Cases and Method：The study involved 48 eyes that received vitreous surgery and 25 fellow eyes. The series 26 males and 14 females. Their ages ranged from 29 to 81 years,average 63 years. The follow-up period ranged from 3 to 12 months,average 6.7 months. There were 29 eyes of proliferative and 19 eyes of nonproliferative retinopathy. Endophotocoagulation was performed 13 eyes. Fluorescein angiograms before and after surgery were used in evaluating reperfusion in retinal areas temporal to the fovea. Findings：Reperfusion was significantly more frequent in operated than in nonoperated eyes. Reperfusion was more frequent in patients aged 65 years or less and in those with HbAlc value below 7％. Conclusion：Nonperfused retinal area may undergo reperfusion after vitreous surgery. Age of patient and HbAlc value are two major related factors.