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要約 目的:今日,中高年の長期ひきこもりが社会問題となっている。今回重篤な増殖糖尿病網膜症(PDR)の40歳台のひきこもり男性2例を経験したので報告する。
症例:2例とも2018年に腎不全などで内科に緊急入院となった。健診の受診歴はなく原因不明のため腎生検が行われ,糖尿病が判明し透析導入となった。眼科では2例とも片眼は硝子体出血(VH)により眼底透見不能,視力は眼前手動弁であったため硝子体手術(VIT)を施行した。僚眼の小数視力は症例1が0.4,症例2は1.0であり,汎網膜光凝固を施行した。症例1は2か月後VHのため視力0.1となりVITを施行した。
結果:2例とも片眼のVIT後の視力は手動弁または光覚弁に終わった(症例2は2回手術)。症例1の僚眼は,VIT中に精神的不穏となり中止に至った。視力は0.3に改善したが,全身麻酔下での再手術を計画中に自宅で高カリウム血症による心肺停止となり,搬送された後は受診が途絶えた。症例2の僚眼は0.8の視力を保っている。
結論:中高年の長期ひきこもりでは,糖尿病など全身疾患が放置され,重篤化して初めて医療が開始される場合がある。眼科的難症例では長時間の手術が必要なため,精神的脆弱さが懸念されれば全身麻酔を選択すべきと思われた。
Abstract Purpose:In recent times social withdrawal(Hikikomori)in middle and old age has become a social problem. We here report 2 cases of Hikikomori of individuals in their forties with severe proliferative diabetic retinopathy(PDR).
Cases:Both cases were hospitalized for cryptogenic renal failure which renal biopsy revealed to be due to diabetes. Hemodialysis was started. One eye of each case of which vision was hand motion because of severe vitreous hemorrhage(VH)was vitrectomized. Another eye of which the decimal vision was 0.4 in case 1 and 1.0 in case 2 was panretinally photocoagulated. This eye in case 1 underwent vitrectomy 2 months later for VH. The vision was 0.1.
Results:The final vision of one eye which had been vitrectomized was hand motion or light perception. case 2 underwent two operations. During the vitrectomy of the one eye of case 1, the patient became delirious and the operation was suspended. Although the vision improved to 0.3, a second operation under general anesthesia was planned. The patient developed cardiopulmonary arrest at home because of hyperpotassemia before the planned surgery. The other eye of case 1 maintained vision of 0.8.
Conclusion:Systemic diseases such as diabetes in some cases of Hikikomori in middle and old age are neglected and not treated until they become very severe. General anesthesia should be considered for treating refractory eyes if the patient is suspected to be cognitively too weak for long-duration surgery.
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