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増殖糖尿病網膜症に続発した血管新生緑内障7例10眼に手術を行い,その5年後の視機能を検討した。手術時年齢は44~63歳(平均51歳)であった。経扁平部水晶体切除と硝子体手術を用い,硝子体と増殖膜を除去して剝離網膜を復位させ,鋸状縁まで汎網膜光凝固を行った。虹彩ルベオーシスは全例で消失した。手術1か月後の視力は,光覚なし2眼,光覚弁2眼,0.2が1眼,0.5以上6眼であり,5年後の視力は,光覚なし3眼,光覚弁1眼,0.1が1眼,0.5以上5眼であった。術後に視力が著明に低下した症例はなかった。5年後の眼圧は,40mmHg以上2眼,低眼圧1眼で,他の7眼は正常範囲にあった。以上,術後5年間の観察で,視力が著明に低下した症例はなかった。血管新生緑内障でも,術後虹彩ルベオーシスが消退して眼圧が正常化した症例では,長期間にわたって視機能が保存できると結論される。
We surgically treated 10 eyes of 7 patients with neovascular glaucoma secondary to proliferative diabetic retinopathy. Their ages at the time of surgery ranged from 44 to 63 years,average 51 years. As the standard procedure,each eye received pars plana lensectomy and vitrectomy. Reattachment of the retina was induced by excision of vitreous and proliferative membrane. Panretinal photocoagulation was performed up to the ora serrata. Rubeosis iridis disappeared in all the eyes after surgery. Visual acuity before surgery was no light perception 2 eyes,light perception 2 eyes,0.2 one eye and 0.5 or over 5 eyes. Visual acuity 5 years after surgery was no light perception 3 eyes,light perception one eye,0.1 one eye and 0.5 or over 7 eyes. There was no instance of marked decrease in visual acuity after surgery. Intraocular pressure 5 years after surgery was over 40mmHg 2 eyes,hypotonic 1 eye,and was within normal range 7 eyes. The findings show that visual acuity can be maintained for 5 years when surgery induces resolution of neovascular glaucoma.
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