臨床眼科71巻1号

2017年01月発行

特集 眼疾患の一次予防と二次予防—眼疾患はどこまで予防可能か？

糖尿病網膜症の一次予防と二次予防

著者： 北野滋彦¹

所属機関： ¹東京女子医科大学糖尿病センター眼科

ページ範囲：P.28 - P.32

はじめに

　網膜症の疫学的研究，臨床研究をもとに，一次予防として網膜症なしから網膜症の発症，二次予防として網膜症の早期発見，重症化予防のエビデンスについて解説する。

　まず，網膜症の一次予防は，糖尿病と診断されてから，網膜症が発症するリスク因子を明確にして，リスクを軽減することによってどの程度網膜症の発症を阻止することができるかが重要になってくる（表1）^1〜15）。二次予防は，網膜症の早期発見の有用性となっているが，同時に網膜症の重症化に関するリスク因子と，リスクの軽減による網膜症の重症化阻止のエビデンスを把握することが重要になってくる。

参考文献

1）Klein R, Klein BE, Moss SE et al：The Wisconsin epidemiologic study of diabetic retinopathy：Ⅱ. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 102：520-526, 1984

2）Klein R, Klein BE, Moss SE et al：The Wisconsin epidemiologic study of diabetic retinopathy. Ⅲ. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol 102：527-532, 1984

3）Miyazaki M, Kubo M, Kiyohara Y et al：Comparison of diagnostic methods for diabetes mellitus based on prevalence of retinopathy in a Japanese population：the Hisayama Study. Diabetologia 47：1411-1415, 2004

4）Kawasaki R, Tanaka S, Tanaka S et al：Incidence and progression of diabetic retinopathy in Japanese adults with type 2 diabetes：8 year follow-up study of the Japan Diabetes Complications Study（JDCS）. Diabetologia 54：2288-2294, 2011

5）Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes：UKPDS38. UK Prospective Diabetes Study Group. BMJ 317：703-713, 1998

6）The Accord study group and Accord eye study group：Effect of medical therapies on retinopathy progression in type 2 diabetes. N Engl J Med 363：233-244, 2010

7）The effect of intensive treatment on the progression of diabetic retinopathy in insulin-dependent diabetes mellitus. Diabetes Control and Complications Trial. Arch Ophthalmol 113：36-51, 1995

8）Ohkubo Y, Kishikawa H, Araki E et al：Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus：a randomized prospective 6-year study. Diabetes Res Clin Pract 28：103-117, 1995

9）White NH, Sun W, Cleary PA et al：Prolonged effect of intensive therapy on the risk of retinopathy complications in patients with type 1 diabetes mellitus：10 years after the Diabetes Control and Complications Trial. Arch Ophthalmol 126：1707-1715, 2008

10）ACCORDION Eye Study Group and ACCORDION Study Group：Persistent effect of intensive glycemic contro on retinopathy in type 2 diabetes in the ACCORD follow-on study. Diabetes Care 39：1089-1100, 2016

11）Sjølie AK, Klein R, Porta M et al：Effect of candesartan on progression and regression of retinopathy in type 2 diabetes（DIRECT-Protect 2）：a randomized placebo-controlled trial. Lancet 1385-1393, 2008

12）Chew EY, Klein ML, Ferris FL 3rd et al：Association of elevated serum lipid levels with retinal hard exudates in diabetic retinopathy. Early Treatment Diabetic Retinopathy Study（ETDRS）Report 22. Arch Ophthlmol 114：1079-1084, 1996

13）Effect of aspirin treatment on diabetic retinopathy. ETDRS report number 8. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 98：757-765, 1991

14）Chaturvedi N, Sjolie AK, Stephenson JM et al：Effect of lisinopril on progression of retinopathy in normotensive people with type 1 diabetes. The EUCLID Study Group. EURODIAB Controlled Trial of Lisinopril in Insulin-Dependent Diabetes Mellitus. Lancet 351：28-31, 1998

15）Davis MD, Fisher MR, Gangnon RE et al：Risk factors for high-risk proiferative diabetic retinopathy and visual loss. ETRDS #18. Invest Ophthalmol Vis Sci 39：233-252, 1998

16）Keech A, Mitchell P, Summanen PA et al：Effect of fenofibrate on the need for laser treatment for diabetic retinopathy（FIELD study）：a randomized controlled trial. Lancet 370：1687-1697, 2007

17）Wilkinson CP, Ferris FL 3rd, Klein RE et al：Proposes international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology 110：1677-1682, 2003