糖尿病網膜症における網膜血管床閉塞の修復過程

Revascularization of occluded capillary bed in diabetic retinopathy

　糖尿病網膜症で網膜血管床閉塞部位を追跡すると，血行が再開し修復が行われる事例があり，不規則に屈曲したコイル状血管をみることがある。73例93眼の糖尿病網膜症眼を対象とし，螢光眼底造影を用いて血管床閉塞部位を経時的に観察した。その結果，64眼69％に部分的な血行再開が観察され，5眼に広範囲にわたる血行再開がみられた。血行再開の様式は再疎通と再構築に大別され，再構築はさらに網膜内新生血管と血管再形成に分けられた。血行再開の時期は血管閉塞が極期を過ぎた時期であった。再疎通の一部および再構築の経過を追うとコイル状血管に変化した。コイル状血管の多くは，血管床修復部位に現れ，ほとんどは静脈系血管からなり，糖尿病網膜症の過去の病歴を反映するものであると結論された。

We studied the pattern of revascularization in areas of occluded capillary bed in 93 eyes with diabetic retinopathy by means of high-resolution fluorescein angiography. Areas of occluded retinal capillary bed were partially reperfused in 64 of 93 eyes, 69%. Reperfusion took place either by recanalization or remodelling. Vascular remodel-ling included intraretinal neovascularization and new buildup of capillary network. Recanalizationusually started after cessation of progress of capil-lary occlusion. Recanalized capillaries and newly formed capillary network tended to show a coil-like vascular pattern.

Coil-like vessels are a frequent finding in diabet-ic retinopathy. The majority of such vessels involve retinal venules. We postulate that the presence of coil-like vessels in diabetic retinopathy is manifes-tation of revascularization in areas of prior capil-lary nonperfusion.