治療開始後に肺結核への罹患が判明した糖尿病網膜症3例

Three cases of pulmonary tuberculosis detected after start of treatment for diabetic retinopathy

要約　目的：増殖糖尿病網膜症の治療開始後に肺結核のあることが判明し，結核の治療後に硝子体手術を行った3症例の報告。

症例：1例は女性，2例は男性で，年齢はそれぞれ31，54，59歳である。3例とも未治療の増殖糖尿病網膜症として受診した。

所見と経過：それぞれ3か月，4か月，7か月の隔離と肺結核に対する加療を必要とした。3例とも結核の治療中に増殖網膜症が進行し，視力が低下した。硝子体手術により，術前と術後の視力は，それぞれ0.1から0.7，0.1から0.4，0.04から0.5に改善した。

結論：肺結核に併発した増殖糖尿病網膜症では，結核の治療中での不十分な眼科診療や，厳格な血糖コントロールにより，網膜症が悪化することがあることをこれら3症例は示している。増殖糖尿病網膜症，特に長期間未治療の症例では，呼吸器症状があるとき，結核感染にも注意するべきである。

Abstract　Purpose：To report 3 cases of proliferative diabetic retinopathy who was detected to have pulmonary tuberculosis and who received vitreous surgery after control of tuberculosis.

Cases：One was a female and two were males. They were aged 31, 54 and 59 years respectively. All the 3 cases were referred to us as untreated proliferative diabetic retinopathy.

Findings and Clinical Course：Panretinal photocoagulation was started in each of the 3 cases but had to be interrupted to treat tuberculosis. Treatment of tuberculosis, including isolation, lasted for 4, 3 and 7 months respectively. During the interruption, diabetic retinopathy progressed and resulted in decreased visual acuity. After vitreous surgery, visual acuity improved from 0.1 to 0.7, from 0.1 to 0.4, and from 0.04 to 0.5 respectively.

Conclusion：These cases illustrate that diabetic retinopathy may aggravate during treatment for tuberculosis, due probably to strict control of blood sugar and incomplete treatment of retinopathy. Pulmonary tuberculosis ought to be kept in mind when treating neglected diabetic retinopathy, particularly when respiratory symptoms are present.