黄斑剝離を伴う裂孔原性網膜剝離に対する硝子体手術・経強膜手術後の視力推移とOCT所見

Visual outcome and optical coherence tomographic features following primary vitrectomy or scleral buckling for rhegmatogenous retinal detachment involving the macula

要約　黄斑に及ぶ裂孔原性網膜剝離60眼のうち46眼には硝子体手術，14眼には経強膜手術を行った。両群間に術後視力と光干渉断層計（OCT）所見の差があるかを検索した。術前平均視力は硝子体手術群が0.06，経強膜手術群0.26であったが，術後平均視力はそれぞれ0.73と0.69で有意差がなかった。手術2週間後での2段階以上の視力改善率は，硝子体手術群で76％，経強膜手術群が36％で有意差があった（p=0.009）。この時点で検眼鏡的には全例で網膜が復位していたが，OCT上での残存剝離が硝子体手術群の13％，経強膜手術群の55％にあり，これらでの術後視力改善は残存剝離のない例よりも有意に少なかった（p＝0.009）。硝子体手術群での術後早期からの視力改善には黄斑完全復位が関与していると結論される。

Abstract.　We reviewed the surgical outcome in 60 eyes of rhegmatogenous retinal detachment involving the macula. Primary vitrectomy was performed on 46 eyes and conventional scleral buckling was performed on 14 eyes. Both groups were evaluated by means of postoperative visual acuity and optical coherence tomography（OCT）. Preoperative visual acuity averaged 0.06 in vitrectomy group and 0.26 in buckling group. Postoperatively,it averaged 0.73 and 0.69 respectively. Visual acuity 2 weeks after surgery improved by two lines or more in 76％ of eyes in the vitrectomy group and in 36％ in buckling group. The difference was significant（p＝0.009）. While fundscopy showed the retina to be reattached in all the 60 eyes,OCT showed residual retinal detachment in 13％ of vitrectomy group and in 55％ in buckling group. Visual acuity improved more in eyes without residual retinal detachment than the rest（p＝0.009）. Early reattachment of the macula appeared to be a major cause of earlier visual rehabilitation following primary vitrectomy.