硝子体出血で発見された20歳のインシュリン依存型糖尿病の1症例

Vitreous hemorrhage led to detection of insulin-dependent diabetes mellitus at twenty years of age

　糖尿病網膜症の発症と進展には，高血糖，罹病期間ならびに遺伝的素因が関与すると言われている。インシュリン依存型糖尿病における増殖網膜症の発症には，少なくとも3〜5年以上の罹病期間が必要とされている。今回筆者らは糖尿病の病歴がなく，両眼霧視を主訴として初めて来院し，両眼硝子体出血を伴う網膜新生血管と網膜出血を認め，入院後にインシュリン依存型糖尿病と初めて診断された20歳の女性の症例を経験した。唯一の病歴は2年前の急激な体重減少と生理不順であり，全く無症状で経過し，20歳の若年齢で初めて増殖網膜症（硝子体出血あり）を認めた点は非常に興味深いと思われた。

A 20-year-old female presented with blurring of vision in both eyes. We observed vitreous hemor-rhage, widespread retinal hemorrhages and disc neovascularization in both eyes. The fasting blood sugar level was 437 mg/dl with HbA_1c, value of 15. 2%. She was apparently free of symptoms sugges-tive of diabetes mellitus except acute loss of body weight from 58kg to 40kg during the foregoing 2 years. We diagnosed her as insulin-dependent diabetes mellitus complicated with advanced proliferative diabetic retinopathy. As it usually takes 3 to 5 years for diabetic retinopathy to prog-ress from nonproliferative to proliferative stage, it appeared that her retinopathy started to progress during the period of loss of body weight. To our knowledge, proliferative diabetic retinopathy in insulin-dependent diabetes mellitus under 20 years of age has been reported in only 9 instances.