白内障手術後の糖尿病網膜症経過

Course of diabetic retinopathy after cataract surgery

　糖尿病患者の白内障手術後の網膜症進行を術式間で比較した。術式は嚢内摘出術151例225眼，嚢外摘出術79例96眼，嚢外摘出で後房眼内レンズ挿入178例237眼であり，経過観察期間はそれぞれ平均26，20，19か月であった。網膜症の発症，増殖網膜症の発症，硝子体出血の発生，虹彩新生血管または血管新生緑内障の発生，黄斑症の進行について，術前と術後6か月および最終診察時とを比較した。嚢内摘出術と嚢外摘出術を比較すると，網膜症の発症頻度が嚢外摘出術で有意に高いことを除けばその他の項目については両術式の間に差がみられなかった。眼内レンズ挿入例は術前の網膜症がより軽度のものに行われていたが，術後網膜症は確実に進行していた。

We reviewed the records of 403 diabetic persons who had undergone cataract surgery to evaluate the implication of cataract surgery on the later course of diabetic retinopathy. A total of 558 eyes were involved, including intracapsular cataractextraction (ICCE) 225 eyes, extracapsular cataract extraction (ECCE) 96 eyes and ECCE with poste-rior chamber intraocular lens implantation (PCL) 237 eyes. The follow-up period averaged 26 months for ICCE, 20 for ECCE and 19 for PCL. We compar-ed the state of diabetic retinopathy at 6 months after surgery and at the final follw-up examina-tion. There were no differences between ICCE and ECCE groups concerning incidence of vitreous hem-orrhage, iris neovascularization, neovascular glau-coma, exacerbation of maculopathy, or develop-ment of proliferative retinopathy in eyes with or without background retinopathy. There was a higher incidence of manifestation of retinopathy in eyes without prior retinopathy in ECCE than in ICCE group. Eyes in PCL group showed lesser inci-dence of above items except significant progression of retinopathy after cataract surgery.