硝子体手術後失明した糖尿病性牽引性網膜剥離眼の検討

Analysis of blinded cases of diabetic traction retinal detachment after closed vitrectomy

　1981年3月より1984年3月までの間に硝子体手術を行った128眼の糖尿病性牽引性網膜剥離症例中19眼（14.8％）が，術後に失明しているので，これら失明例の失明原因ならびにその予防法について検討した．

　19眼中，術中に網膜が復位しえなかった症例は4眼（21.1％）であり，その内3眼は，活動期のT型もしくはY型全網膜剥離例であった．

　術中に網膜を復位しえた15眼中8眼（53.3％）は網膜剥離の再発から，また，5眼（33.3％）は血管新生緑内障から失明に至っている．しかもこれら13眼中6眼（46.2％）では，術後の硝子体腔中への再出血が網膜剥離もしくは血管新生緑内障発生のきっかけとなっている．

　これらの結果より，T型もしくはY型全網膜剥離例では，網膜相互の癒着が強固になる以前に硝子体手術を行うべきであり，術後の頑固な再出血が予測される症例ならびに，術後の硝子体腔中のフィブリン析出等の炎症性変化が再網膜剥離を誘発すると思われる症例では硝子体切除後にシリコンオイルを硝子体腔中に注入し，再出血ならびに炎症性変化の起こる"場"をなくすことが必要であると考える．

During a 2-year-period, closed vitrectomy was performed on 128 eyes with diabetic retionpathy associated with traction retinal detachment. Im-provement in visual acuity or visual field resulted in 93 eyes (73%), while blindness ensued in 19 eyes (15%) as the final outcome. This paper deals with the involved factors in these 19 eyes with poor prog-nosis.

The retinal detachment failed to reattach in 4 eyes despite vitrectomy and combined procedures. Total traction retinal detachment showing T or Y type was present preoperatively in 3 of these 4 eyes. The retina was reattached during surgery in the other 15 eyes. In 8 of these eyes (53%), intractable retinal detachment, similar to proliferative vitreore-tinopathy, occurred following vitrectomy. Phthisis bulbi resulted in another 5 eyes (33%) consequent to rubcosis iridis. In 6 of these 13 eyes, rebleeding in the vitreous seemed to act as a trigger for these proliferative and/or rubeotic changes.

The findings indicate that vitrcctomy has to be performed prior to formation of firm interretinal adhesion. Also, silicone oil injection into the vitreous after vitrectomy would prevent massive vitreous rebleeding and/or inflammatory reactions.