糖尿病網膜症における周辺部凝固と黄斑部凝固の凝固順序

Evaluations on the topological order of scatter and focal photocoagulation in diabetic retinopathy

　周辺部凝固と黄斑部凝固の望ましい順序を知るために，検眼鏡的に黄斑浮腫を伴う前増殖および増殖網膜症で，汎網膜光凝固を行った116例206眼をretrospectiveに検討した。血管アーケードの内と外のどちらを優先凝固したかで，内優先群，外優先群，内外同時群の3つのグループに分類した。結果は内優先群28眼では，悪化10眼（36％），不変17眼（60％），改善1眼（4％）。外優先群146眼では悪化41眼（28％），不変98眼（67％），改善7眼（5％）。内外同時群32眼では，悪化0眼（0％），不変30眼（94％），改善2眼（6％）であった。内外同時群は悪化例がなく，他の2群との間には有意差があった。黄斑浮腫眼の汎網膜光凝固は，周辺部凝固と黄斑部凝固を同時にバランスよく行うことが，術後経過中の視力低下も少なく良好な結果であった。

We made a retrospective study on the optimal order of photocoagulation for the macular and peripheral retina in the treatment of diabetic retinopathy. The subjects comprised 206 eyes of 116 patients with preproliferative or proliferative retinopathy with macular edema. The eyes were treated either by argon or krypton laser. They were divided into 3 groups : A) 28 eyes in which macular treatment preceded peripheral treatment, B) 32 eyes in which macular and peripheral treatments were performed simultaneously, C) 146 eyes in which peripheral treatment preceded macular treatment. After an average of 27 months, visual acuity improved or remained unchanged in 64% in group A, 100% in group B and 72% in group C. Regarding posttreatment deterioration in vision, the findings in group B was significantly better than in group A or C. We advocate that photocoagulation for the macular and peripheral retina be applied simultaneously in the treatment of preproliferative or proliferative diabetic retinopathy.