糖尿病性牽引性網膜剥離に対する硝子体手術後のフィブリン析出

Fibrous exudation after vitrectomy for diabetic retinopathy with traction detachment

　糖尿病性牽引性網膜剥離に対する硝子体手術67眼のうち，26眼（39％）に術後眼内へのフィブリン析出を認めた．フィブリン析出は眼外冷凍凝固，糖尿病のコントロール不良，腎機能障害，フィブリノーゲン高値，網膜症の活動性が高いことが要因として考えられた．術後フィブリン析出の対策として，術前に十分な光凝固を行い網膜症を抑制すること，術中のアドレナリン添加眼内灌流液の使用と眼外冷凍凝固の抑制が有効である．

We evaluated the postoperative course after vit-rectomy in a consecutive series of 67 eyes with traction-induced macular detachment due to dia-betic retinopathy. Particular attention was paid to the incidence and possible causative factors of fibrinous exudation in the anterior chamber or the vitreous following surgery.

A total of 26 eyes (39%) manifested prominentfibrinous exudation in the form of membranes and/ or masses. Following predisposing factors were identified : exoapplication of cryoretinopexy, poor blood-sugar control, marked renal dysfunction, high fibrinogen level in the serum and markedly active diabetic retinopathy.

Postoperative fibrinous exudation was a major factor for the unfavorable prognosis of vitrectomy. In order to minimize this complication, we advocate sufficient panretinal photocoagulation prior to or during surgery, addition of adrenalin in the irrigat-ing solution during vitrectomy, and curtailment of cryoretinopexy.