重症な若年者増殖糖尿病網膜症に対する硝子体手術

Vitrectomy for severe proliferative diabetic retinopathy in young adults

　水晶体摘出・硝子体手術の際に，網膜症が重症であるために眼内レンズ挿入を断念した若年者糖尿病網膜症10例11眼を検討した。術前から3眼に血管新生緑内障を，1眼に牽引性網膜剥離を合併していた。手術は，超音波水晶体手術，硝子体手術の後，眼内光凝固を周辺部まで十分に行い，血管新生緑内障では毛様体光凝固も併用した。術後，5眼（45％）で血管新生緑内障のために再手術を要した。最終矯正視力は0.1以上が6眼（55％），0.01〜0.09が1眼（9％），0.01未満が4眼（36％）であった。眼内レンズ挿入を断念するほどの重症例では，たとえ徹底的な硝子体手術を行っても予後不良例が少なくなく，早期手術が望まれると考えられた。

We reviewed 11 eyes of 10 patients treated by vitrectomy and lensectomy for severe proliferative diabetic retinopathy. Their ages ranged from 22 to 39 eyes, average 32 years. Intraocular lens implantation was not performed because of advanced retinopathy. Neovascular glaucoma was present in 3 eyes and traction retinal detachment in 1 eye prior to surgery. All the eyes received extensive endophotocoagulation after phacoemulsification-aspiration and vitrectomy. Eyes with neovascular glaucoma received additional cyclophotocoagulation. Five eyes (45%) needed a second surgery for neovascular glaucoma. Final visual acuity was better than 0.1 in 6 eyes (55%), between 0.09 and 0.01 in one eye (9%), and less than 0.01 in 4 eyes (36%). These cases illustrate that the surgical outcome may be poor in advanced proliferative retinopathy. An early surgery is the preferred method of treatment for such cases.