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要約 目的:糖尿病黄斑浮腫に対して硝子体手術が行われたのち,眼科治療とは関係なく,全身因子と関連して両眼の眼底所見が変動した2症例を報告する。症例と経過:症例は53歳の男性と40歳の女性で,前者には増殖糖尿病網膜症とびまん性黄斑浮腫があり,汎網膜光凝固と硝子体手術後も黄斑浮腫が軽減しなかった。糖尿病腎症によるネフローゼが改善し,5か月後に黄斑部網膜厚が減少し,黄斑浮腫が軽減した。後者には15年前から糖尿病があり,増殖網膜症と黄斑浮腫があった。汎網膜光凝固と硝子体手術で黄斑浮腫は軽減しなかった。貧血とヘモグロビン値が上昇するとともに,黄斑浮腫が改善した。結論:これら2症例では汎網膜光凝固と硝子体手術後に存在した黄斑浮腫が全身因子と関連して変動した。糖尿病黄斑浮腫の治療では全身因子の制御も必要である。
Abstract. Purpose:To report two cases who received vitreous surgery and who showed fluctuation of diabetic maculopathy concomitant with systemic findings without direct ocular intervention. Cases and Findings:One was a 53-year-old male and the other was a 40-year-old female. The first case had proliferative diabetic retinopathy with macular edema that persisted after panretinal photocoagulation and vitrectomy. Systemic treatment for nephropathy and nephrosis resulted in reduced foveal thickness and improved macular edema 5 months later. The second case had diabetes mellitus for 15 years and had proliferative retinopathy with macular edema that persisted after panretinal photocoagulation and vitrectomy. Macular edema regressed after treatment for anemia and hypohemoglobinemia. Conclusion:Macular edema that failed to improve after panretinal photocoagulation and vitrectomy fluctuated concomitant with changes in systemic factors. Control of systemic factors is essential in the treatment of diabetic macular edema.
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