糖尿病性黄斑浮腫に対するtwo step療法

Two-step therapy for diabetic macular edema

　糖尿病網膜症でびまん性黄斑浮腫を呈した12症例14眼に対して，ステロイド剤の全身投与ののち，黄斑への局所または格子光凝固を行った。術後2段階以上の視力改善は8眼57％にあり，視力不変は5眼36％，視力悪化は1眼7％であった。1例2眼で網膜症が悪化した。糖尿病網膜症での黄斑浮腫を光凝固単独では改善しがたいので，この2段階治療方式は今後積極的に検討されてよいと結論された。

We treated 14 eyes, 12 patients, who manifested diffuse macular edema as complication of diabetic retinopathy. All the patients were under insulin therapy. As the first step of treatment, patients were given peroral prednisolone at the initial daily dosis of 30 mg. After improvement of funduscopic findings or visual acuity, we applied photocoagula-tion using dye laser either as focal or grid coagula-tion. At the end of averaged of 3.5 months aftercessation of prednisolone, visual acuity improved by 2 lines or more in 8 eyes, 57%, remained un-changed in 5 eyes, 36%, and deteriorated in 1 eye, 7%. The funduscopic feature of retinopathy ag-gravated in 2 eyes, apparently due to systemic corticosteroid.

As photocoagulation alone does not induce visual improvement in the presence of diabetic macular edema, the present two-step therapy promises to be of value in this clinical situation.