| 特集名 | 糖尿病性腎症への進歩した腎代替療法―その標準化と個別化 | |
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| 題名 | 合併症とその対策 (3) 眼合併症の予防と対策 | |
| 発刊年月 | 2014年 01月 | |
| 著者 | 加賀 達志 | 社会保険中京病院眼科 |
| 著者 | 市川 一夫 | 社会保険中京病院眼科 |
| 【 要旨 】 | ほとんどの糖尿病（DM）透析患者は視覚障害を伴っているため，それらに配慮した透析環境の整備や看護が重要である． DM透析患者の網膜症は透析により安定することが多い．網膜症進行予防の観点からも透析導入時期を検討すべきである．白内障手術は，術後の網膜症進行が少ないため，積極的な手術が望まれる．硝子体手術は，症例によっては必要最小限の手術にすることで術後成績はよく，通常透析で日帰り手術も可能であり，個別化治療の対象と考えられる． 透析による眼圧上昇は見過ごされやすいため，透析終了直後に眼科受診をすべきである． 帯状角膜症は近年減少傾向にあり適切な透析管理の結果と思われるが，長期透析では微小血管閉塞による網脈絡膜萎縮が問題となってきている． |
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| Theme | Up-to-date renal replacement therapy for diabetic nephropathy -- Standardization and personalization | |
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| Title | Prevention and management of eye diseases in diabetic dialysis patients | |
| Author | Tatsushi Kaga | Department of Ophthalmology, Social Insurance Chukyo Hospital |
| Author | Kazuo Ichikawa | Department of Ophthalmology, Social Insurance Chukyo Hospital |
| [ Summary ] | Since many diabetic (DM) dialysis patients are visually impaired, it is necessary we improve dialysis facilities and enhance the nursing system so that these systems can be accessible to these patients. Retinopathy in DM dialysis patients often stabilizes when they receive dialysis. If retinopathy is worsening, it is necessary to have discussions with patients' dialysis doctors concerning initiation of dialysis in order to prevent worsening retinopathy. Since retinopathy progression is seldom seen in DM dialysis patients after cataract surgery, it is desirable we perform cataract surgery on these patients. In DM dialysis patients who have no active retinopathy after long-term dialysis, it is necessary we minimize surgery to achieve optimum results. In such cases, outpatient surgery is desirable to maintain normal dialysis schedule. In dialysis patients with obstruction of aqueous humor outflow, disequilibrium syndrome increases inter ocular pressure (IOP). Because IOP decreases after dialysis, the patients should see an ophthalmologist as soon as possible after a dialysis treatment. The number of band keratopathy cases has declined in recent years, which can be attributed to provision of adequate dialysis therapy. However, chrorioretinal atrophy caused by microvascular vasoconstriction in long-term DM dialysis patients has become an issue. |
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