増殖糖尿病網膜症に対する硝子体手術後の視力の経過

Visual outcome after vitrectomy for proliferative diabetic retinpathy

　1986年〜1990年の5年間に硝子体手術を施行した増殖糖尿病網膜症のうち，1年間以上経過観察可能であった55症例62眼の長期視力予後を生命表法を用いて検討した。対象を手術適応により，1群：3か月以上硝子体出血の消退しないもの（黄斑外牽引性剥離を含む），2群：黄斑剥離のあるものと2つに分けて解析した。視力生存率は，1群では術後18か月以降は67.5％，2群では術後12か月以降は31.8％となり，差を認めた（P＜0.05）。視力表にて2段階以上の術後視力の改善は，1,2群合わせて51.6％であり，2群間に有意差を認めた（P＜0.05）。術後緩徐に視力が低下した症例もみられ，増殖糖尿病網膜症の視力予後判定には，継続した長期にわたる経過観察が必要であると考えられた。

We performed vitreous surgery for proliferative diabetic retinopathy in 92 eyes 56 months through 1990. We reviewed the visual outcome in 62 eyes, 55 cases, who could be followed up for one year or longer. A life table analysis by Kaplan-Meire was used in the evaluation. The series comprised 40 eyes which were operated for vitreous hemorrhage persisting for 6 months or more (group 1) and 22 eyes with tractional retinal detachment involving the macula (group 2).

Reattachment of the retina was achieved in 55 eyes, 89%. The final visual acuity improved in 83% of eyes in group 1 and in 32% of eyes in group 2, average 52% in both groups. Visual improvement in group 1 resulted in 90% at 1 month after surgery and in 68% at 18 months. Visual improvement in group 2 resulted in 55% at 1 month and 32% at 12 months. The differences between the two groups were significant (p ＜0.05). Out of 32 eyes with postoperative visual improvement, 4 eyes showed gradual late decrease in vision, either due to diabetic maculopathy, cataract or epimacular membrane.