増殖糖尿病網膜症に対する硝子体手術10年後視力予後因子の統計学的検討

Ten-year visual outcome following vitreous surgery for proliferative diabetic retinopathy

要約　目的：硝子体手術を行った増殖糖尿病網膜症の10年後視力の報告。対象と方法：2002年までに初回硝子体手術を行った増殖糖尿病網膜症460例512眼のうち，10年以上の術後経過が追跡できた73例109眼を対象とした。男性62眼，女性47眼で，手術時の年齢は23〜71歳，平均51歳であった。2眼を除く107眼は2型糖尿病であった。視力はlogMARとして評価した。結果：平均視力は術後6か月では0.34，10年後では0.22であり，有意差がなかった。術後に黄斑牽引または網膜剝離が生じた症例と，複数回手術の症例では10年後視力が低下した。虚血性心疾患の既往がある15眼では，6か月後の平均視力が0.23で，10年後では0.02に低下した。脳梗塞が生じた6眼では，6か月後の平均視力が0.07で，10年後では0.06であった。結論：硝子体手術を行った増殖糖尿病網膜症の10年後の視力不良因子は，黄斑牽引，網膜剝離，複数回の手術，虚血性心疾患，脳梗塞であった。

Abstract.　Purpose：To present a report on 10-year visual outcome following vitreous surgery for proliferative diabetic retinopathy. Cases and Method：We reviewed 109 eyes of 73 cases who received vitreous surgery for proliferative diabetic retinopathy at Fukuoka University Chikushi Hospital during 12 years through 2002 and who were followed up for 10 years or longer after surgery. The series comprised 62 male and 47 female eyes. The age ranged from 23 to 71 years, average 51 years, at the time of initial surgery. All the cases except 2 eyes had been diagnosed with type 1 diabetes mellitus. Visual acuity was evaluated in terms of logMAR. Findings：Visual acuity averaged 0.34 6 months after surgery and 0.22 ten years after surgery. The difference was not significant. Ten-year visual acuity was poorer in eyes with macular traction, retinal detachment, or multiple surgery. Ischemic heart failure was present in 15 eyes. Visual acuity averaged 0.23 6 months after surgery and 0.02 ten years after surgery. There were 6 eyes that developed cerebral infarction. Visual acuity averaged 0.07 6 months after surgery and 0.06 ten years after surgery. Conclusion：Factors for 10-year visual outcome comprised macular traction, retinal detachment, multiple surgery, ischemic heart failure, and cerebral infarction.