増殖糖尿病網膜症に対する硝子体手術での病態による手技の選択と結果

Methods and outcome of vitreous surgery for different types of proliferative diabetic retinopathy

　1994年12月までの2年間に硝子体手術を行った増殖糖尿病網膜症71眼につき，眼内病態に基づく手術方法と手術結果を検討した。眼内病態は，網膜症の活動性，後部硝子体剥離の程度，裂孔原性網膜剥離の有無および周辺部増殖膜の有無により判断した。初回手術成功は71眼中64眼（90％）。再手術はすべて水晶体切除を行い、最終的な手術成功は71眼中70眼（98.6％）であった。増殖糖尿病網膜症の手術成績は，周辺部まで硝子体を十分に切除し，増殖膜を取り残さず，術中に網膜を復位させて十分に光凝固を行えば良好であり，術前の眼内病態把握と必要な併用術式の選択が大切である。

We performed vitreous surgery as the first surgical treatment on 71 eyes of proliferative diabetic retinopathy during the forgoing 2-year period. Additional lensectomy and/or scleral encircling were perfomed on eyes with active retinopathy, vitreous traction in the periphery, rhegmatogenous retinal detachment or proliferative lesions in the periphery. The surgery was successful in 64 eyes, 90%, when evaluated after the follow up of 9 months or more. Second surgery with lensectomy was performed in 6 of the 7 eyes without initial success. A total of 70 eyes, 98.6%, could be cured at the final evaluation. We advocate subtotal removal of the vitreous and proliferative tissue with additional intraoperative photocoagulation after reattachment of the retina. Detailed appraisal of the intraocular findings and due selection of surgical methods are essential to achieve success.