糖尿病網膜症に対する局所光凝固の経過

Outcome of focal photocoagulation for diabetic retinopathy

　糖尿病網膜症76眼（前増殖糖尿病網膜症［preproiiferative diabetic retinopathy：PPDR］66眼，増殖糖尿病網膜症［PDR］10眼）に対して，局所光凝固を施行した。光凝固前の黄斑症の合併はPPDR50眼，PDR7眼にみられたが，そのうちPPDR7眼，PDR1眼の計8眼（全体の11％）に，光凝固後に黄斑浮腫の増強をきたした。黄斑浮腫の増強は凝固数の多寡とは関係がなかった。光凝固後2年から4年5か月の経過観察中，30眼（PPDR24眼，PDR6眼）で光凝固の追加を要し，このうち16眼で汎網膜光凝固（panretinal photocoagulation：PRP）になった。螢光眼底所見を仁木らの分類に従い分けた場合，後極型25眼中6眼，中間型36眼中7眼，周辺型5眼中0眼，全体型1眼中1眼にPRPが必要となった。Hb_A1cが10％以上のものは19眼中8眼（42％）にPRPを要した。

We treated 76 eyes of diabetic retinopathy with focal photocoagulation. The retinopathy was preprolifera-tive in 66 eyes and proliferative in 10. Diabetic maculopathy was initially present in 50 eyes in the former group and in 6 in the latter. Following photocoagulation, it increased in 7 eyes in the former group and in one in the latter. The number of burns was not correlated to the incidence of increased macular edema. During the follow up for 24 to 53 months, average 36 months, additional focal photocoagulation became nacessary in 24 eyes in the former and in 6 in the latter group. Panretinal photocoagulation had to be performed in 16 eyes. In these 16 eyes, 8 had elevated levels of HbAic over 10%. The initial 76 eyes were classified, according to montage fluorescein angiographic by Niki, as posterior type 25 eyes, midperipheral type 36, pheripheral type 5, and diffuse type 1. Panretinal photocoagulation had to be performed in 6, 7, none and 1 eye respectively in the above four groups.