糖尿病性網膜症に対する硝子体手術成績—成績向上への対策

Clinical studies on pars plana vitrectomy for proliferative diabetic retinopathy

　著者らの所属する3施設で最近5年間に実施した増殖糖尿病性網膜症217眼（195例）の硝子体手術成績を発表し，その向上に必要な対策を考察した．視力改善率は平均56.2％で，54年以前の43％（13眼）より58年の67％（43眼）まで徐々に向上しつつあるが，今後の成績向上への対策としては，対象を最終視力低下時より3カ月以内，視力が術前0.01以上のものにしぼるのがよいと結論された．

We evaluated a consecutive series of 217 eyes with proliferative diabetic retinopathy treated by pars plana vitrectomy performed by one of the authors during a 7-year period ending 1983. All the eyes were operated either by VISC-X or Oc-utome and were followed up for 6 months or more postoperatively. Visual improvement was achieved in 122 of the 217 eyes (56%). The rate of visual improvement was 49% before 1979 and increased to 67% in 1983. In a series of 33 eyes, in which vitrectomy was performed within 3 months after the last episode of visual disturbance, visual im-provement was achieved in 29 eyes (88%). In 74 eyes, in which vitrectomy was performed more than one year after the last episode, visual improve-ment was achieved in only 41%.

The visual acuity at the time of surgery was a significant factor for the postoperative success. In 13 eyes in which the visual acuity was light percep-tion, only 2 eyes (15%) attained a postoperative visual acuity of 0.1 or more. In 82 eyes in which the visual acuity was 0.01 or more at the time of surgery, 44 eyes (54%) regained a postoperative visual acuity of 0.1 or more.

A better surgical outcome is thus expected in cases with preoperative visual acuity of 0.01 or more and persistence of visual disturbance for less than 6 months.