増殖性糖尿病性網膜症による網膜剥離の硝子体手術術直後視力不良例と手術適応について

Surgical outcome of diabetic retinopathy with retinal detachment. Surgical indication in poor prognosis cases

　過去3年間に増殖性糖尿病性綱膜剥離200眼に硝子体手術を行い，172眼（86％）に復位を得た．術前視力指数弁以下で術後復位した83眼をもとに，推定剥離期間，網膜剥離形態，増殖血管の程度と術後視力との関連を検討し，手術適応について考察を加えた．

　剥離期間が6カ月以内の症例で，0.01以上の視力改善をみたものは90.4％であったが，13カ月以上の症例では16.7％であった．術後0.01以上の視力回復を得た症例の平均剥離期間は，5.5カ月±3.9月であり，指数弁以下の症例では13.0カ月±7.3月と有位な差を認めた（P＜0.01）．83眼の剥離形態別での視力予後は，テーブルトップ型が最も悪く，長期間剥離の症例が多いためと思われた．剥離期間が1年以内の症例をみると，豊富な増殖血管を伴うものは視力予後は不良であった．

　増殖性糖尿病性網膜剥離は，視力予後の点から考えると，剥離期間が6カ月以内に手術するべきである．また，黄斑剥離が13カ月以上にわたる症例は，原則的には手術適応外と考えられる．

We reviewed a consecutive series of 200 eyes that underwent closed vitrectomy because of diabetic retinopathy with retinal detachment during the foregoing 3 years. Reattachment of the retina resulted in 172 eyes (86%).

The series included 83 eyes with preoperative visual acuity less than counting fingers. In 42 eyes, retinal detachment had been present for less than 6 months. Visual acuity improved in 38 eyes (90%) after surgery. In 12 eyes, retinal detachment had persisted for 13 months or more prior to surgery.Visual acuity improved in 2 eyes (17%).

In 57 eyes with postoperative visual acuity of 0.01 or more, the duration of retinal detachment prior to surgery averaged 5.5+3.9 months. In 26 eyes with final visual acuity of counting fingers or less, the duration of retinal detachment averaged 13.0+7.3 months.

There were 37 eyes with table top type of retinal detachment. The postoperative visual acuity was particularly poor in this group due to the longer duration of detachment before surgery. Florid retinopathy showed a tendency for poor prognosis. These findings indicate that diabetic eyes with retinal detachment persisting for 13 months or more are not indicated for closed vitrectomy.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(3) : 227-231, 1988