糖尿病黄斑症に対する光凝固の適応と限界

Indication and limitation of photocoagulation for diabetic maculopathy

（R2-7PM−22）　糖尿病黄斑浮腫54例75眼に対して黄斑局所光凝固を行い，5年以上の長期経過を観察した。視力改善は，びまん性浮腫の48％，局所浮腫の21％で得られ，黄斑浮腫は87％で消失した。0.7以上の最終視力は35眼（47％）で得られ，その背景因子は，尿蛋白（−）（P＝0.005），高度の黄斑沈着なし（P＝0.01），嚢胞様浮腫なし（P＝0.03）であった。0.2以下の最終視力は18眼（24％）であり，その背景因子は尿蛋白（3＋以上）（P＝0.002），高度または中心窩の黄斑沈着（P＝0.001），嚢胞様浮腫（P＝0.01）であった。光凝固前の視力が0.7以上の症例では77％が最終視力0.7以上に，0.2以下の症例では47％が最終視力0.2以下になった。以上の成績は，良好な最終視力を得るためには早期の黄斑局所光凝固が必要であること，腎症や高度の黄斑沈着が予後不良因子であることを示す。

We treated 75 eyes of 54 patients with diabetic macular edema by macular focal photocoagulation. After follow up of 5 years or more, the visual acuity improved in 48% of eyes with diffuse macular edema and in 21% of eyes with focal macular edema. Macular edema dissolved in 87% of the eyes. Final visual acuity of 0.7 or over was obtained in 35 eyes (47%). They were characterized by the absence of proteinuria (p =0.005), of advanced hard exudate in the macula (p=0.01) , and of cystoid macular edema (p = 0.03) . Final visual acuity of 0.2 or less resulted in 18 eyes (24%) . They were characterized by proteinuria of 3 + or more (p 0.002) , advanced or foveal hard exudate (p = 0.001) , and cystoid macular edema (p = 0.01) . When the initial visual acuity was 0.7 or more, 77% of eyes obtained final visual acuity of 0.7 or more. When the initial visual acuity was 0.2 or less, 47% of eyes resulted in final visual acuity of 0.2 or less. The findings show that early focal macular photocoagulation is necessary to achieve good final visual acuity in eyes with diabetic macular edema. Presence of nephropathy and advanced hard exudate in the macula are major prognostic factors for poor visual outcome.