硝子体手術後に発生した血管新生緑内障に対する眼内光凝固予防効果

Endophotocoagulation during vitrectomy as prophylaxis for postoperative neovascular glaucoma in proliferative diabetic retinopathy

　硝子体手術中の眼内光凝固による汎網膜光凝固が，術後の新生血管緑内障の発症予防にいかなる効果があるかを調べた。

　対象は，術前にほとんどあるいは全く光凝固が行われていなかった増殖型糖尿病性網膜症の60例69眼で，全例に硝子体手術，シリコンオイルタンポナーデを施行し，術後最低3ヵ月間の経過観察中には網膜再剥離が認められなかった症例である。

　術中に眼内光凝固を汎網膜的に行った13例16眼中には術後血管新生緑内障を発症した例はなかった。他の47例53眼には術中に汎網膜光凝固を行わず，術後に汎網膜光凝固を施行したが，そのうち5眼に血管新生緑内障が発症し，その3眼は無水晶体眼であった。

　硝子体手術中に眼内光凝固を汎網膜的に施行することは，術後の血管新生緑内障発症予防に効果があると思われる。

We evaluated the value of panretinal endo-photocoagulation during closed vitrectomy in preventing postoperative neovascular glaucoma. A series of 69 eyes, 60 cases, of diabetic retinopathy underwent closed vitrectomy. These eyes had not been treated by photocoagulation of any signifi-cance prior to surgery. Panretinal endo-photocoagulation was applied to 16 eyes in the series during vitrectomy. The remaining 53 eyes were treated by conventional panretinal photocaogulation after vitrectomy. All the cases were followed up for 3 months or more after sur-gery.

No instance of neovascular glaucoma developed among the 16 eyes treated by endophotocoagula-tion. Neovascular glaucoma developed in 5 eyes in the 53 eyes. Of these 5 eyes, 2 were phakic and 3 aphakic. Massive fibrinous response immediately after vitrectomy developed in 4 eyes (25%) treated by endophotocoagulation and in 26 eyes (49%) treated otherwise.

The findings indicate that panretinal endo-photocoagulation during vitrectomy is more effec-tive in preventing neovascular glaucoma than con-ventional panretinal photocoagulation after sur-gery.