増殖糖尿病網膜症に対する小切開白内障と硝子体同時手術の適応

Surgical results and indications of vitrectomy combined with small incision cataract surgery for proliferative diabetic retinopathy

　増殖糖尿病網膜症に対して小切開白内障・硝子体同時手術を施行した55例75眼の手術成績を調査し，同時手術の適応について考察した。平均経過観察期間は14.3±9.8か月であった。20眼で術中タンポナーデを併用，高度近視眼1眼と術中に広範な剥離があるタンポナーデ併用の8眼で眼内レンズ挿入術を行わず，それ以外の症例では硝子体手術終了時に眼内レンズ挿入術を行った。術前術後で2段階以上の視力改善がタンポナーデ非併用群で78％，併用群で55％と非併用群で比較的良好な視力予後を得た。術後併発症中，フィブリン反応が非併用群で13％，併用群で40％，虹彩後癒着が非併用群で11％，併用群で25％と，併用群で術後炎症の強さを示した。再手術も非併用群で20％，併用群で40％と併用群に多く，網膜剥離が重篤で長期タンポナーデが必要であるような症例では眼内レンズは二次挿入とするのが適切であると考えられた。

We reviewed a series of 75 eyes with proliferative diabetic retinopathy treated by simultaneous vitrectomy and small-incision lens extraction. The follow-up period averaged 14.3±9.8 months. Phacoemul-sification was performed through a self-sealing wound at the limbus prior to vitrectomy. Intraocular lens (IOL) was implanted in 66 eyes after vitrectomy was completed. IOL implantation was not performed in nine eyes because of large retinal detachment (eight eyes) and high myopia (one eye). Intravitreal gas or silicone oil tamponade was performed in 20 eyes. Visual acuity improved by 2 lines or more in 78% of eyes without tamponade and in 55% of eyes with tamponade. The incidence of fibrin reaction and posterior synechia after surgery was higher in the tamponade group. Eyes in the tamponade group necessitated more additional operations. The findings suggest that simultaneous lens extraction, vitrectomy and IOL implantation are safe and effective for eyes with proliferative diabetic retinopathy. We advocate against primary IOL implantation for severe cases of retinopathy which would require longterm tamponade.