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糖尿病黄斑浮腫15例20眼に対して硝子体手術を行った。18眼には白内障手術を併用した。後部硝子体剝離があるか,または未剝離で視力が0.4以下の11眼には内境界膜剝離を行った。12~19(平均14)か月の経過観察を行い,最終視力は改善が10眼,不変が8眼,悪化が2眼であった。内境界膜剝離を行った11眼では,改善が5眼,不変が5眼,悪化が1眼であった。蛍光眼底造影で後極部の色素漏出は13眼(65%)で軽減し,内境界膜剝離群では9眼(82%)で軽減した。重篤な術後合併症はなかった。糖尿病黄斑浮腫に対して硝子体手術が有効であり,症例によっては内境界膜剝離が奏効すると結論される。
We performed vitreous surgery for diabetic macular edema in 20 eyes of 15 patients. Cataract surgery was simultaneously performed in 18 eyes. Internal limiting membrane(ILM)was removed in 11 eyes with posterior vitreous detachment(PVD)or in those with no PVD and with visual acuity of 0.4 or less. The follow-up period ranged from 12 to 19months,average 14months. The final visual acuity improved by 2 lines or more in 10 eyes,remained unchanged in 8 eyes,and deteriorated in 2 eyes. In 11 eyes that received ILM removal,the final visual acuity improved in 5 eyes,remained unchanged in 5 eyes,and deteriorated in 1 eye. Fluorescein angiography showed reduced dye leakage in the posterior fundus area in 13 eyes(65%)in the whole series and in 9 eyes(82%)that received ILM removal. There was no severe complication throughout. The findings show that vitreous surgery may be effective for diabetic macular edema. Additional ILM removal may be indicated in selected cases.
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