| 特集名 | 透析患者のスクリーニング検査 -- 透析合併症の防止と健診 | |
|---|---|---|
| 題名 | 透析患者にとって重要となるスクリーニング (6) 眼底 | |
| 発刊年月 | 2009年 02月 | |
| 著者 | 大越 貴志子 | 聖路加国際病院眼科 |
| 【 要旨 】 | 眼底検査は失明につながる眼疾患の早期発見のみならず，脳血管障害のリスクを予測するうえで重要である．本邦では無散瞳眼底カメラによる動脈硬化判定が広く普及しており，これまで数多くの研究から脳血管疾患の予知に関する眼底所見の意義が判明している．眼底検査による脳卒中予知は血圧，心電図による脳卒中予知と重複することの少ない独立性の高いものである．糖尿病網膜症も，眼底検査による早期発見が失明防止につながる疾患の一つである．また，本邦で中途失明原因の第1位である緑内障も，眼底検査により早期発見が可能である．透析患者にとってのスクリーニング眼底検査の有用性に関しては未だエビデンスがないため，今後さらなる研究が望まれる． | |
| Theme | Preventive Medical Screening and Health Check-ups for Dialysis patients | |
|---|---|---|
| Title | Screening fundal examination for hemo-dialysis patients | |
| Author | Kishiko Ohkoshi | Department of Ophthalmology, St. Luke's International Hospital |
| [ Summary ] | Fundal examination is important for preventative health care, not only to screen for specific eye diseases but also to predict cerebrovascular diseases. In Japan, photographic examination without pupillary dilation has been performed to screen for retinal arteriosclerotic changes for several decades. There has been a great deal of evidence which has shown that retinal arteriosclerotic levels correlate with incidence of stroke. The prevalence of these ocular findings is more common in patients receiving hemodialysis. Eighty percent of patients at induction of hemodialysis displayed ocular findings and more advanced arteriosclerotic levels than the general public. Fundal examination for screening of diabetic retinopathy is also important because, there has been strong evidence that laser photocoagulation is effective to prevent blindness if it is performed in a timely fashion. In diabetic patients, therefore, fundal examination is recommended annually regardless of retinopathy stage. Recently, glaucoma has become a leading cause of blindness in Japan. Diagnostic criteria for glaucoma include optic disc cupping which is detectable with fundal screening examinations. Fundal examination as a mode of screening thus seems to be important for patients receiving hemodialysis. However, there has been no evidence to prove the efficacy of this examination for decrease mortality, morbidity, or blindness in hemodialysis patients. Further studies are necessary to assess the efficacy of fundal examinations. |
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