増殖糖尿病網膜症に対する25ゲージ硝子体手術成績

Outcome of 25-gauge vitrectomy for proliferative diabetic retinopathy

要約　目的：増殖糖尿病網膜症に対する20ゲージ（G）と25G硝子体手術の成績の比較。対象と方法：同一術者が52か月間に硝子体手術を行った増殖糖尿病網膜症108例136眼を対象とした。45眼には最初の16か月間に20G，91眼にはこれに続く36か月間に25Gを用いた手術を行った。周辺部まで硝子体を切除し，鋸状縁まで光凝固を行った。25Gの91眼中，ベバシズマブを術前に12眼，術後に8眼に注入した。結果：術後の視力には，20G群と25G群とで差はなった。20G群に比し，25G群では手術時間が短く，術中の裂孔形成が少なかった。累計手術回数は，20Gでは平均1.4回，25Gでは平均1.2回であった。25G群での視力転帰には，裂孔形成とシリコーンオイル置換が関与した。結論：増殖糖尿病網膜症に対する硝子体手術で，25Gでは20Gと同様な視力転帰が得られ，手術時間が短縮し，術中の医原性網膜裂孔の頻度が減少した。

Abstract.　Purpose：To compare the outcome of 20 G and 25 G vitrectomy for proliferative diabetic retinopathy（PDR）. Cases and Method：This study was made on 136 eyes of 108 patients who received vitrectomy by a single surgeon during 52 months. Vitrectomy was performed with 20 G on 45 eyes during the first 16 months and with 25 G during the next 36 months. Vitrectomy was performed up to the farthest periphery. Photocoagulation was applied up to the ora serrata. Bevacizumab was injected in 12 eyes before and in 8 eyes after surgery in 25 G group. Results：There was no difference in final visual outcome between 20 G and 25 G group. The 25 G group differed from the 20 G group regarding shorter duration of surgery and lesser incidence of intraoperative retinal tear formation. Sessions of surgery averaged 1.4 in 20 G group and 1.2 in 25 G group. Silicone oil tamponade and retinal tear formation were major factors for the visual outcome in 25 G group. Conclusion：In vitrectomy for PDR,use of 25 G resulted in the same visual outcome as 20 G,in shorter duration of surgery,and lesser incidence of retinal tear formation.