糖尿病性網膜症での剥離網膜血管

Avulsed retinal vessels in diabetic retinopathy

　剥離網膜血管（avulsed retinal vessel：ARV）のある糖尿病性網膜症例36眼の臨床所見を検討した。36眼のすべてが増殖性網膜症で，高頻度に網膜光凝固術あるいは硝子体出血の既往があった。ARVは耳側網膜に多発し，また，すべて赤道部より後極の網膜静脈に存在していた。後部硝子体はすべての症例でARVに牽引のある部分剥離であった。また，ARVの位置に網膜新生血管が7眼（19％）に観察された。経過を観察できた21例のうち新たに7例（33％）に硝子体出血が生じた。網膜新生血管が生じた例は皆無であった。

　以上より，糖尿病性網膜症でのARVの発生には，網膜光凝固術による網膜内層の破壊，硝子体出血による硝子体の収縮，およびNVを介する網膜血管と硝子体の強固な接着が関与していると推測された。

We evaluated 36 eyes in 31 diabetic subjects with avulsed retinal vessels. Proliferative retinopathy was present in all the eyes. Photocoagulation had been performed in 33 eyes, 92%. Past history of vitreous hemorrhage was present in 28 eyes, 83% All the avulsed vessels were venous in nature and were located posterior to the equator. When seen by biomicroscopy, all the avulsed vessels were suspended in the vitreous cavity by vitreous strands. New vessels were present at the site of avulsed vessel in 7 eyes, 19%. The avulsed vessels appeared to be etiologically related to destruction of inner retinal layers by photocoagulation, vitre-ous shrinkage secondary to vitreous hemorrhage, and vitreous traction through newly formed vessels.