対糖尿病網膜症硝子体手術における超高灌流圧下での増殖膜処理

Treatment of fibrovascular membrane under hyper-infusion pressure during vitrectomy for prolifer-ative diabetic retinopathy

　活動性の高い線維血管性増殖組織を伴う糖尿病性黄斑部牽引性網膜剥離16例17眼に対し，硝子体手術中，超高灌流圧下で一時的に網膜中心動脈を途絶させた状態にして増殖膜の処理を行った。この間ほぼ完全な術中止血が得られ，超高灌流圧は82mmHgから105mmHgで，その持続時間は0.9分から最高16.5分（平均4.1分）に及んだ。その結果，16眼（94％）に網膜復位が得られ，15眼（88％）に視力改善が認められたが視力悪化例はなかった。

　超高灌流圧下での増殖膜処理は良好な視認性により術中合併症を防止し，手術時間を短縮するとともに手術成績も向上させた。また，増殖糖尿病網膜症でも10分間以上の虚血に耐えると考えられた。

We performed vitrectomy on 17 eyes, 16 patients, with proliferative diabetic retinopathy. All the eyes manifested active fibrovascular proliferation with tractional detachment of the macula. During treat-ment of the proliferative membrane, the infusion pressure was temporarily elevated to induce cessa-tion of blood flow in the central retinal artery. Infusion pressure of 82 to 105,mmHg resulted in practical hemostasis. The duration of hemostasis ranged from 0.9 to 16.5 minutes, average 4.1 min-utes. The retina became reattached in 16 eyes,94%. The visual acuity improved in 15 eyes, 88%. There was no instance of deterioration of visual acuity in the series. The present technique of hyper-infusion pressure resulted in better visualization of the membrane, prevention of perioperative complica-tions, shortening of duration of surgery and improvement in the surgical outcome. Eyes with proliferative diabetic retinopathy were found to tolerate ischemia for 10 minutes or longer.