両眼に全層黄斑円孔を生じた症例の視力予後

Visual prognosis in cases with bilateral full-thickness macular holes

要約　目的：特発性黄斑円孔が両眼に発症した症例で，先に発症した眼と後に発症した眼の視力予後などを比較検討した。

対象と方法：すでに片眼の全層黄斑円孔と診断され，他眼も2017〜2025年に全層黄斑円孔を発症した9例18眼を対象とした。先に黄斑円孔を発症した初発眼9眼と，後に発症した後発眼9眼を比較したところ，診断時の平均最小円孔径は，初発眼535μmと比較し後発眼は426μmと小さかった（対応のあるt検定，p＝0.009）。logMAR視力は，初発眼0.95と比較し後発眼は0.44と良好であった（同p＝0.003）。手術を希望しない初発群1眼を除き，基本的に白内障硝子体手術，内境界膜剝離（症例により翻転法も），ガスタンポナーデを施行した。初回円孔閉鎖率は，初発眼75％，後発眼100％で，再手術後に全例閉鎖した。

結果：最終logMAR視力は初発眼，後発眼とも0.22であり，有意差はなかった。初発眼より後発眼が術前の最小円孔径は小さく，術前視力は良好であったが，両群ともほぼ変わりない比較的良好な視力が得られていた。

結論：初発群より後発群が術前視力は良好であり，後から黄斑円孔を発症した際の受診時期は早まっていると思われるが，最終視力は同等という結果となり，症例数を増やすことが課題と考えられた。

Abstract　Objective：We examined the visual prognosis between the eye with earlier onset and the eye with later onset in a patient with bilateral idiopathic macular holes.

Subject：This study included 9 patients with 18 eyes who had already been diagnosed with full-thickness macular holes in one eye and subsequently developed full-thickness macular holes in the other eye between 2017 and 2025. Comparing the 9 eyes of the primary eye（where the macular hole developed first） with the 9 eyes of the secondary eye（where it developed later）, the mean minimum hole diameter at diagnosis was smaller in the secondary eye（426 μm） than in the primary eye（535 μm）（paired t-test, p＝0.009）. LogMAR visual acuity was better in the secondary eyes（0.44） than in the primary eyes（0.95）（p＝0.003）. Except for one primary eye where surgery was declined, all eyes underwent cataract-vitrectomy surgery with internal limiting membrane peeling（and inverted ILM flap technique in some cases） and gas tamponade. The initial hole closure rate was 75％ in the initial eye and 100％ in the secondary eye；all cases closed after reoperation.

Result：Final logMAR visual acuity was 0.22 in both the initial and secondary eyes, showing no significant difference. Although the secondary eye had a smaller preoperative minimal hole diameter and better preoperative visual acuity than the initial eye, both groups achieved relatively good visual acuity that was comparable.

Conclusion：The secondary eye had better preoperative visual acuity than the initial eye, and it appears that the time to presentation was earlier when macular holes developed later. However, the final visual acuity was equivalent, suggesting that increasing the number of cases is a challenge.