妊娠後のインスリン強化療法により糖尿病網膜症が発症増悪したが予後良好であった1症例

A case with diabetes who started strict blood sugar control during pregnancy and developed retinopathy that deteriorated rapidly and healed spontaneously

要約　目的：糖尿病合併妊娠の血糖降下治療後に増殖糖尿病網膜症を発症したが，光凝固をせずに予後良好であった1例の報告。症例：10歳で2型糖尿病を発症し，20年間血糖高値が続いた。30歳で妊娠し，第8週からインスリン強化療法を開始すると網膜症が発症して増悪し，両眼の軽い硝子体出血（VH）に至った。治療5か月後から網膜症は軽快に転じ，右眼は順調に経過した。治療7か月後での出産後左眼に著明なVHを生じ，10か月後の手術時に乳頭上新生血管膜を認め剝離したが，網膜自体は良好で光凝固は行わなかった。最終視力は両眼とも0.9であった。結論：糖尿病合併妊娠において，血糖是正を契機に網膜症が発症しVHにまで至った場合でも，網膜症が自然寛解する場合がある。

Abstract.　Purpose：To report a case of a pregnant woman with diabetes who developed retinopathy following strict blood sugar control. It deteriorated into a proliferative stage and then healed spontaneously without photocoagulation. Case：A woman developed type 2 diabetes at the age of 10. For the next 20 years the blood sugar level was high. She got pregnant at 30 and started strict blood sugar control. She developed diabetic retinopathy, that deteriorated into the status of vitreous hemorrhage（VH）in both eyes. Her retinopathy began to heal in the 5th month after beginning of the therapy. Her right eye followed a favorable course. She bore a boy in the 7th month from the beginning of the therapy. Then her left eye developed severe VH which was vitrectomized 10 months later. During surgery a neovascular membrane on the optic disc was excised. The retina's condition was good enough needing no photocoagulation. Visual acuity was 0.9 in either eye at the final visit. Conclusion：In pregnant women with diabetes who develop retinopathy following strict blood sugar control, the retinopathy, which even deteriorates into the status of VH, may heal spontaneously.