白内障手術後の糖尿病黄斑浮腫の病態と進展予測

Pathogenetic and prognostic features of diabetic macular edema following cataract surgery

　白内障手術後の糖尿病黄斑浮腫（黄斑浮腫）進展の病態を解明するために，白内障手術時に前房水を採取した2型糖尿病患者44例（44眼）を対象に，6か月間の経過観察にてコホート研究を行った。予後因子として，前房水中のvascular endothelial growth factor （VEGF）とinterleukin-6（IL−6）濃度，黄斑前の後部硝子体の状態，前房蛋白濃度，1年間のHbA_1c平均値，罹病期間を取り上げた。白内障手術6か月後の黄斑浮腫の推移は，悪化26％，不変56％，改善19％であった。黄斑浮腫進展に関与する因子としては，前房水中のVEGFとIL-6濃度，黄斑前の後部硝子体の状態，前房蛋白濃度があげられ，これらの要因は黄斑浮腫進展において相互に関与していることが示唆された。

We performed a cohort study on 44 eyes of 44 patients with type Ⅱ diabetes who underwent cataract surgery. The series comprised 22 males and 22 females. Their ages ranged from 56 to 78 years, average 67.5 years. Simple diabetic retinopathy was present in 38 eyes and preproliferative retinopathy in 6. Macular edema was absent in 19 eyes (43%) and present in various degrees in 25 (57%). We evaluated the following features prior to or during surgery:interleukin-6 and vascular endothelial growth factor (VEGF) in the aqueous, aqueous protein, state of premacular vitreous, one-year average of HbA_1c, and duration of diabetes. During 6 months after cataract surgery, macular edema progressed in 26%, remained stationary in 56%, and improved in 19%. Following features were identified as risk factors for progression of macular edema:interleukin-6 and VEGF in the aqueous, the state of premacular vitreous, and aqueous protein. These four factors seemed to be synergistically involved in the pathogenesis of macular edema.