糖尿病網膜症の術前光凝固術が硝子体手術成績に及ぼす影響

Significance of prior photocoagulation on the outcome of vitreous surgery for diabetic retinopathy

　硝子体手術を行った糖尿病網膜症例106眼について，術前の光凝固術の程度が硝子体手術操作や予後に及ぼす影響を，後部硝子体剥離の進行度に着目しながら検討した。術前光凝固術の程度と後部硝子体剥離の程度とは相関しており（p＜0.05），汎網膜光凝固術完成群では完全後部硝子体剥離の割合が高く，手術合併症は有意に減少した。術後矯正視力（0.4）以上の視力良好例は汎網膜光凝固術群で63％，部分光凝固術群で37％，光凝固未施行群では33％あり，術後視力は光凝固術の程度と相関していた（p＜0.001）。光凝固術後は，視機能保持の観点から，後部硝子体剥離に伴う網膜前出血や網膜牽引などの初期変化が認められれば硝子体手術の適応を考慮すべきである。

We evaluated the effect of retinal photocoagulation on the incidence of posterior vitreous detachment and on the outcome of vitrectomy in 106 eyes with diabetic retinopathy. The incidence of posterior vitreous detachment was positively correlated with the extent of photocoagulation (p＜0.05).Postsurgical complications including iatrogenic retinal break were significantly less after panretinal photocoagulation (PRP). The final visual acuity of 0.4 or better was 63%, 37% and 33% in eyes with PRP, incomplete PRP and no photocoagulation respectively. Visual outcome was also positively correlated with the extent of photocoagulation (p＜0.001). Early vitreous surgery is indicated when posterior vitreous detachment becomes manifest associated by preretinal hemorrhage or retinal traction.