真菌性眼内炎の内視鏡併用硝子体手術

Endoscopy-assisted vitreous surgery for fungal endophthalmitis

真菌性眼内炎8例10眼に対し，内視鏡を併用する硝子体手術を行った。年齢は44～66歳（平均56歳）である。硝子体手術は経扁平部3門で行い，ファイバー式内視鏡を用いた。抗真菌薬を全身的に投与した。経瞳孔的に眼内の視認が困難でも，内視鏡による観察で手術が続行でき，基底部や毛様体部までの郭清をすることができた。術後6～72か月（平均30か月）の観察で形態的改善が8眼，悪化が2眼あった。矯正視力は5眼で2段階以上改善し，3眼が不変，2眼で低下した。内視鏡を併用する硝子体手術は経瞳孔的に眼内の視認が困難な症例でとくに有効で，硝子体や菌塊の郭清が可能であった。

Purpose：To evaluate cases that received endoscopy-assisted vitreous surgery for fungal endophthalmitis. Cases：This retrospective study comprised 10 eyes of 8 patients. Nine patients had endogenous and one had exogenous endophthalmitis. The age ranged from 44 to 66 years,average 56 years. Method：A 3-port closed vitreous surgery was performed with adjunct use of fiber-optic endoscope. Patients received systemic antifungal agents. Results：Surgery could be performed even when transpupillary observation was not possible. After follow-up for 6 to 72months,average 30months,anatomical improvement was obtained in 8 eyes. Visual acuity improved in 5 eyes by 2 lines or more,remained unchanged in 3,and deteriorated in 2. Conclusion：Endoscopy-assisted vitreous surgery was useful for fungal endophthalmitis,particularly when transpupillary observation was difficult or impossible.