人工透析患者における増殖糖尿病網膜症の硝子体手術成績

Outcome of vitrectomy for proliferative retinopathy in diabetic patients under dialysis

　最近の透析患者21例29眼（透析群）の糖尿病網膜症硝子体手術成績を，同時期の非透析患者に同手術を行った211眼（非透析群）と比較検討した。20眼中19眼（95.0％）で復位して非透析群（95.8％）と差はなく，2段階以上の視力改善も82.8％で非透析群70.6％と差はなかった。さらに術前貧血治療実施以前の透析患者（旧透析群）14眼との比較検討では，復位率（旧透析群69.2％），視力改善率（旧透析群50.0％）とも透析群で有意に良好であり，光覚を失った症例は旧透析群5眼（35.7％）に対して，透析群1眼（3.4％）と少なかった。以上より，網膜剥離眼でも腎性貧血が改善（Hct値30％以上）していれば，必ずしも硝子体手術の適応外とはならないと考えられた。

We reviewed the outcome of vitrectomy for proliferative diabetic retinopathy in 240 eyes. The series comprised 29 eyes of 21 patients who were under hemodialysis therapy and 211 eyes without hemodialysis. The latter served as control. Anatomical success was achieved in 19 of 20 eyes, 95%, with retinal detachment in dialysis group. This result was the same as in controls, 95.8%. Visual acuity improved by 2 lines or more in 82.8% of dialysis group and in 70.6% of controls. Another earlier group of 14 eyes under hemodialysis and without presurgical treatment for anemia showed anatomical success in 69% and visual improvement in 50%. Postoperative visual loss occurred in 3% of current dialysis group and in 36% in the earlier group. The findings show that vitrectomy is a safe procedure for retinopathy with retinal detachment in diabetic patients under hemodialysis, provided due attention is paid to anemia and hematocrit value is above 30%.