| 特集名 | 透析患者の眼疾患 | |
|---|---|---|
| 題名 | 糖尿病性網膜症と透析 | |
| 発刊年月 | 1998年 11月 | |
| 著者 | 竹田 宗泰 | 市立札幌病院眼科 |
| 【 要旨 】 | 透析導入に至る糖尿病患者では増殖型糖尿病性網膜症と高度の視力障害を伴うことが多い．これに対して，透析が導入されると，糖尿病性網膜症は安定化する方向に向かうことが多い． この際，末期腎症で保存治療が不可能なため，内科的に透析導入する場合は別として，眼科側からの積極的な透析導入には視力だけでなく，透析により改善しうる活動性の網膜症を確認することが必要である．具体的には， 網膜出血，網膜浮腫，硬性白斑(滲出斑)，軟性白斑および硝子体出血の程度と進行の有無で，レーザー光凝固や硝子体手術で改善しない症例である． 透析導入の前後も，レーザー光凝固や硝子体手術を併用して内科と眼科の連携した治療を必要とする． |
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| Theme | Ocular Disease in Hemodialysis Patients | |
|---|---|---|
| Title | Diabetic retinopathy and hemodialysis | |
| Author | Muneyasu Takeda | Department of Ophthalmology, Sapporo City General Hospital |
| [ Summary ] | Most diabetic patients under maintenance hemodialysis had severe visual disturbances with proliferative diabetic retinopathy. However, the condition of those with diabetic retinopathy frequently stabilized or improved after the introduction of hemodialysis. Hemodialysis was introduced to treat decreased kidney function,due to diabetic nephropathy, caused by diabetic retinopathy. We must evaluate whether these retinal lesions are treatable by hemodialysis or not, based on the degree and progression of retinal findings, such as retinal hemorrhages, hard exudate, cotton wool spots, and vitreous hemorrhages. When severe diffuse retinal edema and recurrent vitreous hemorrhages advances, in spite of ophthalmic treatments(laser photocoagulation and/or vitreous surgery), the patient should receive hemodialysis a little earlier in the course of treatment than usual. Before and after the introduction of hemodialysis,patients must receive careful ophthalmic treatment such as laser photocoagulation and vitreous surgery, along with medical therapy. |
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