網膜静脈分枝閉塞症の増殖性病変—103眼の臨床的特徴と光凝固予後に影響する因子

Clinical features and prognostic factors after photocoagulation for proliferative lesions in retinal branch vein occlusion

　最近10年間に札幌医大眼科で網膜静脈分枝閉塞症による新生血管を合併し光凝固を受けた103眼を対象として，新生血管の臨床的特微と光凝固効果を閉塞部位別に検討した．

（1）新生血管発生部位は耳側主要分枝閉塞群で50％が乳頭部に見られた．しかし周辺側分枝群では1例を除きすべて網膜面であった．

（2）光凝固効果は経過観察を行った全例98眼中，新生血管完全消失49％，部分退縮46％，不変5％であった．閉塞部位別に見ると新生血管の消失あるいは縮小では周辺側分枝群で100％，耳側主要分枝群で92％であった．硝子体出血頻度では周辺側分枝群術前74％から術後13％，耳側主要分枝群術前47％から術後24％であった．視力維持，改善は周辺側分枝群93％，耳側主要分枝群85％で全体的に静脈閉塞部位により治療効果が異なる．

（3）光凝固の予後不良の因子として①耳側主要分枝閉塞群②乳頭部新生血管③光凝固不十分の例④牽引性網膜剥離などがあげられる．

A retrospective study was made on a series of 103 eyes with fundus neovascularization following retinal branch vein occlusion during the past 10-year period. Particular attention was paid to the clinical characteristics of the neovascular mem-branes and the effect of photocoagulation withxenon or argon laser.

The optic disc was the chief site of neovascular-ization in 50% of eyes with occlusion of major temporal retinal veins. (Temporal group) Neova-scularizations rarely developed from the optic disc in eyes with occlusion of nasal venous branches or peripheral branches (Periheral group).

Photocoagulation resulted in total regression of neovascularization in 49%, partial regression in 46% and no regression in 5%. Concerning the location of occluded veins, total or partial regres-sion was achieved in 100% of the peripheral group and in 92% of occlusion of major temporal veins. The incidence of vitreous hemorrhage was 74% and 13% each before and after photocoa-gulation in the peripheral group, and was 47% and24% each in the temporal group. The visual acuity either remained the same or improved in 93% of eyes in the peripherally affected group and in 85% of temporally affected one.

Among eyes with proliferative lesions due to branch retinal vein occlusion, following factors are regarded as indicators for less favorable outcome after photocoagulation : 1) occlusion of a major temporal vein, 2) presence of neovascularization on the optic disc, 3) sparsely distributed photoco-agulation scars, and 4) presence of tractional ret-inal detachment.