糖尿病硝子体手術後の残存網膜剥離が再出血に与える影響

Postoperative vitreous hemorrhage and residual retinal detachment in diabetic vitrectomy

　過去34か月間に硝子体手術を行った増殖糖尿病網膜症206眼のうち，黄斑外牽引性網膜剥離が49眼にあった。これに対して，手術終了時に気圧伸展網膜復位術を28眼（強制復位群）に行い，21眼では硝子体腔内に灌流液が充満したままとした（自然復位群）。術後に硝子体再出血が11眼にあった。それぞれ28眼中5眼（18％）と21眼中6眼（29％）であった。49眼のうち38眼では，術前の網膜剥離が血管アーケードに囲まれる面積の半分以上を占めていた。この38眼中，術後再出血は強制復位群27眼中5眼（19％）と自然復位群11眼中6眼（55％）に起こり，両群間に有意差があった（p＜0.05）。広範な牽引性網膜剥離のある増殖糖尿病網膜症への硝子体手術では，気圧伸展網膜復位術を行うことが望ましいと結論される。

We performed vitreous surgery on 206 eyes of proliferative diabetic retinopathy during the foregoing 34 months. Extramacular tractional retinal detachment was present in 49 eyes. These eyes were additionally treated either with intraoperative pneumoretinopexy (28 eyes) or without (21 eyes). Postoperative vitreous rebleeding occurred in 11 eyes, involving 5 eyes with pneumoretinopexy and 6 eyes without. Preoperatively, the retinal detachment had involved more than 50% of the area posterior to the retinal vascular arcades in 38 eyes. In these 38 eyes, vitreous rebleeding occurred in 5 of 28 eyes (19%) with pneumoretinopexy and in 6 of 11 eyes (55%) without. The difference was significant (p ＜0.05). The finding shows the apparent effectiveness of pneumoretinopexy during vitreous surgery for proliferative diabetic retinopathy with extramacular retinal detachment.