糖尿病性網膜症での大量網膜前出血

Massive preretinal hemorrhage in diabetic retinopathy

　糖尿病性網膜症で2乳頭径以上の網膜前出血を生じた93例106眼について，出血の部位と程度が予後とどのように関係するかにつき検索した．出血の部位を各眼ごとに記録し重ね合せることにより，その分布と部位別頻度を計算した．その結果，網膜前出血は網膜硝子体間の癒着の多い血管アーケードに囲まれた後極部に多かった．さらに，6カ月以上経過の追えた72例81眼について，網膜前出血の発症後形成された線維増殖の程度により3群に分けて，それぞれの群で同様の検索をし，さらに網膜症についても検討した．その結果，81眼中線維増殖を残さなかったもの16眼20％，弱い線維増殖を残したもの17眼21％，強い線維増殖を残したもの48眼59％であった．各群を比較して強い線維増殖を残す群ほど，初発した網膜前出血の範囲が広いことが判明した．さらに，線維増殖の程度には，網膜症の活動性と新生血管の数が有意に関与していた．また牽引性網膜剥離は線維増殖のない群では起こらず，線維増殖の弱い群では12％，線維増殖の強い群では69％に合併した．

　以上のことから，網膜前出血は線維増殖の形成ならびに牽引性網膜剥離と密接に関連する重要な病態であると結論された．

We evaluated the fate of preretinal hemorrhage in diabetic retinopathy in regard to the final visual acuity. We reviewed a total of 106 eyes, 93 cases, with pre-retinal hemorrhage greater than 2 disc diameter (DD). The size and the location of hemorrhage were numeri-cally recorded and processed for each eye in the series. Massive preretinal hemorrhage was most frequently located in the posterior fundus area surrounded by the upper and the lower vascular arcades.

We arbitrarily classified 81 eyes, which were followed up for 6 months or more without resorting to vitreous surgery, into three groups according to the fate of preretinal hemorrhage. In the first group including 16 eyes (20%), the preretinal hemorrhage was absorbed leaving no fibrous proliferation. Mild preretinal prolif-eration resulted in the second group of 17 eyes (21%). Marked fibrous proliferation resulted in the third group of 48 eyes (59%). As a marked tendency, eyes with more advanced fibrous proliferation were associated with more massive preretinal hemorrhage. Traction-induced retinal detachment occurred only in eyes with consequent fibrous proliferation, in 12% in group II and in 69% in group III.

Our findings indicate that massive preretinal hemor-rhage is a major etiological factor for preretinal fibrous proliferation and traction-induced retinal detachment in diabetic retinopathy.

Rinsho Ganka (Jon J Clin Ophthalmol) 40(6) : 641-647, 1986