糖尿病黄斑浮腫に対する硝子体手術成績の術式と浮腫の形態による検討

Outcome of vitrectomy for diabetic macula edema. Implication of surgical modality and type of edema

　過去8年間に後部硝子体剥離がない糖尿病黄斑浮腫61眼に硝子体手術を行った。後部硝子体膜の肥厚や増殖膜がない27眼には後部硝子体剥離のみを作成し，これらがある34眼には膜剥離を併せて行った。2段階以上の視力改善が56％に得られ，不変34％，悪化10％であった。後部硝子体剥離のみを行った27眼での改善率は48％，他の34眼では62％であった。黄斑浮腫の形態別での改善率は，びまん性浮腫群59％，嚢胞様浮腫群38％であり，膜剥離を併用したびまん性浮腫群では75％であった。後部硝子体膜肥厚と嚢胞様黄斑浮腫が視力予後に関与することを示す所見である。

We performed vitreous surgery on 61 eyes of diabetic macular edema without posterior vitreous detach-ment (PVD) during the past 8 years. Artificial PVD only was created in 27 eyes with no thickening of posterior vitreous membrane or proliferative membrane. Membrane peeling was additionally performed in the other 34 eyes. The final visual acuity improved by 2 lines or more in 56%, remained unchanged in 34%, and deteriorated in 10%. The visual acuity improved in 48% of 27 eyes receiving artificial PVD only. It improved in 62% in the other 34 eyes. It improved in 59% of eyes with diffuse macular edema and in 38% of eyes with cystoid macular edema (CME). It improved, spe-cifically, in 75% of eyes with diffuse macular edema receiving additional membrane peeling. The findings show that the visual outcome may be dependent on the presence of CME and thickened posterior vitreous membrane prior to sur-gery.