硝子体手術後の糖尿病血管新生緑内障による失明例の検討

Risk factors of neovascular glaucoma following vitreous surgery for proliferative diabetic retinopathy

　増殖糖尿病網膜症に対して硝子体手術が行われ，術後に新生血管緑内障で失明した症例の全身的ならびに眼内の諸因子を検索した。対象は過去6年間に初回硝子体手術を受け，網膜剥離がなく，新生血管緑内障で失明した10例11眼である。同期間に硝子体手術を受け，新生血管緑内障が発症しなかった増殖糖尿病網膜症60例70眼を無作為に抽出し，対照とした。平均年齢は，失明群42.5±14.2歳，対照群55.4±11.7歳であった。失明群の全身的因子として，若年者，血糖コントロール不良，腎機能低下，低アルブミン血症が有意に多く，眼内因子として，滲出型網膜症，光凝固治療無効，シリコーンオイル併用が有意に多かった。失明群の各症例は，これらの因子を4項目以上有していた。これらの因子を多数有する症例については，硝子体手術の時期と方法についての慎重な検討が必要である。

We reviewed the systemic and topical factors in cases of proliferative diabetic retinopathy that resulted in blindness due to neovascular glaucoma after primary vitreous surgery. The series comprised 11 eyes of 10 cases treated by us during the past 6 years. Cases of retinal detachment were excluded. Another series of randomly selected 70 eyes of 60 similarly operated cases without neovascular glaucoma served as control. The ages averaged 42.5 ± 14.2 years in the 10 cases and 55.4±11.7 years in the control. The 10 cases with poor outcome had following siginificant risk factors: relatively younger age, poor blood sugar control, impaired renal function, and hypoalbuminemia. They also had following topical factors: exdudative retinopathy, poor response to photocoagulation, and intraoperative sili-cone oil. Each case in the series had more than four of the above factors. The finding shows that patients with these risk factors need particular attention in the timing and method of vitreous surgery.