眼科未治療の牽引性網膜剥離を伴う増殖糖尿病網膜症の硝子体手術成績

Outcome of vitrectomy for untreated diabetic retinopathy with tractional retinal detachment

（18-D-19）　術前の光凝固未施行で，硝子体手術を施行した牽引性網膜剥離を伴う増殖糖尿病網膜症18例19眼についての手術成績を検討した。15眼には通常の硝子体手術を，4眼には二段階硝子体手術を行った。術前の黄斑部剥離および牽引は13眼（68％）にみられた。通常の方法では，初回手術での医原性網膜裂孔が12眼（80％），液—空気置換を13眼（87％）で必要とし，術後の増殖性硝子体網膜症（PVR）を5眼（33％）に発症したのに対し，二段階法では術中医原性裂孔，PVRの発生はなかった。また術後視力0.1以上は，通常の方法3眼（20％），二段階法3眼（75％）であった。症例によっては，二段階硝子体手術は有効である。

We reviewed the result of vitreous surgery on 19 eyes of proliferative diabetic retinopathy with tractional retinal detachment. These eyes had received no specific treatment before. The macula was affected either by detachment or traction. Conventional vitrectomy was performed on 15 eyes and two-step vitrectomy on 4 eyes. In the 15 eyes in the former group, iatrogenic tear formed in 12 eyes (80%) . Intraoperative fluid/air exchange was performed in 13 eyes (87%). Postoperative proliferative vitreoretinopathy (PVR) developed in 5 eyes (33%) . There was no iatrogenic tear formation nor PVR in the 4 eyes in the latter group. Visual acuity of 0.1 or better was obtained in 3 eyes (20%) in the former group and in 3 eyes (75%) in the latter. The findings show the potential usefulness of two-step vitrectomy in selected cases.