透析糖尿病患者に対する硝子体手術成績

Vitrectomy for diabetic retinopathy in patients under hemodialysis

　透析患者18例26眼と，非透析患者102例136眼の増殖糖尿病網膜症に対して硝子体手術を行った。透析例，非透析例は，さらに網膜剥離群と非網膜剥離群の2群に分けて比較検討した。透析例の術後視力改善率は，非網膜剥離群で13眼中11眼（85％），網膜剥離群で13眼中4眼（31％）で，両群の間には有意差がみられた（P＜0.02）。視力改善率は，透析例の非網膜剥離群（85％）と非透析例の非網膜剥離群（89％）の間に有意差はみられなかった。透析例では，網膜剥離群の6眼（46％）は最終的に失明したが，非網膜剥離群では失明例はなかった。手術後のフィブリン析出，血管新生緑内障，硝子体出血の発現率は，非透析例のほうが透析例より有意に少なかった。また，このような術後合併症は，透析例では，非網膜剥離群のほうが網膜剥離群より有意に少なかった。以上の結果から，透析例の非網膜剥離群は積極的な硝子体手術の適応となるが，透析例の網膜剥離群は予後不良のため積極的な手術適応とはならないと考えた。

We performed vitrectomy for proliferative dia-betic retinopathy in 26 eyes of 18 patients under maintenance hemodialysis therapy. The findings were compared with another series of vitrectomy in 136 eyes of 102 diabetic patients who did not receive hemodialysis. In the hemodialysis group, visual acuity improved in 11 of 13 eyes without retinal detachment and 4 of 13 detached eyes. The differ-ence was significant (p＜ 0.02). Eventual blindness resulted in 6 retinal detachment eyes (46%) and in none of nondetached eyes. In eyes without retinaldetachment, no difference was present in the rate of visual improvement between hemodialysis group (85%) and non-hemodialysis group (89%). Inci-dence of postoperative fibrin formation, rubeotic glaucoma and vitreous hemorrhage was significant-ly less in the non-hemodialysis group than in the hemodialysis group. In the hemodialysis group, incidence of postoperative complications was higher in eyes with retinal detachment than in those without. The findings show that proliferative dia-betic retinopathy with retinal detachment in patients under hemodialysis is poor candidate for vitrectomy because of poor prognosis.