内科および眼科的未治療の重症増殖糖尿病網膜症の臨床像と手術成績

Clinical features and surgical outcome of severe diabetic retinopathy without prior treatment

要約　目的：未治療の重症糖尿病網膜症の臨床像と手術成績の報告。対象と方法：過去21か月間に糖尿病網膜症に対する硝子体手術を行い，6か月以上の経過を追えた26例35眼を対象とした。男性26眼，女性9眼で，年齢は23〜70歳，平均43歳である。全例がそれまで糖尿病の治療を受けておらず，当科受診後に糖尿病の治療を開始した。結果：全例が2型糖尿病で，70％の症例が10％以上のHbA1c値を示した。46％の症例に顕性腎症があった。視力は指数弁以下が13眼（37％），0.1未満が10眼（29％）であり，硝子体出血が2眼（6％），牽引性網膜剝離が21眼（60％），血管新生緑内障が2眼（6％）であった。術後の最終視力は，改善69％，不変17％，悪化14％であった。術後視力に影響する因子は，術前視力，牽引性網膜剝離，初診時のHbA1c，腎症の病期，初診から手術までの日数，HbA1cの改善値であった。結論：未治療の重症糖尿病網膜症であっても，迅速に血糖をコントロールし，早期の硝子体手術を行うことで，視力が改善または維持する可能性がある。

Abstract.　Purpose：To report the clinical features and surgical outcome of severe diabetic retinopathy without prior treatment. Cases and Method：This study was made on 35 eyes of 26 patients who underwent vitreous surgery during the past 21 months. The series comprised 26 male and 9 female eyes. The age ranged from 23 to 70 years, average 43 years. All the cases had received no medical treatment before visiting us. Cases were followed up for 6 months or longer after surgery. Results：All the cases had type 2 diabetes mellitus. Value of HbA1c was 10％ or over in 70％ of cases. Manifest nephropathy was present in 46％ of cases. Visual acuity was light perception or less in 13 eyes（37％）, and 0.1 or less in 10 eyes（29％）. Vitreous hemorrhage was present in 2 eyes（6％）, tractional retinal detachment in 21 eyes（60％）, and neovascular glaucoma in 2 eyes（6％）. Final visual acuity improved in 69％, remained unchanged in 17％, and deteriorated in 14％. Following factors influenced the visual outcome：initial visual acuity, retinal detachment, initial value of HbA1c, stage of nephropathy, interval between initial visit and surgery. Conclusion：These cases illustrate that early surgery and control of diabetes and surgery may result in improved or sustained visual acuity in severe diabetic retinopathy.