黄斑円孔術後のガス注入眼に対する短期QOL改善を目的としたガス液置換

Short-time improvement of quality of life by fluid-gas exchange after macular hole surgery

要約　背景：黄斑円孔手術後の腹臥位は患者への負担が大きい。高い円孔閉鎖率とともに腹臥位の期間短縮が望ましい。目的：術後早期にガスを抜去し良好な結果が得られた症例の報告。対象と方法：過去3年間に第3期黄斑円孔に硝子体剝離のみを作製し，C₃F₈で硝子体腔を充填し，術後8～14日（平均10日後）にガス液置換を行った11例11眼を対象とした。平均年齢は66歳である。内境界膜の剝離は行わず，10眼では白内障の同時手術を行った。術翌日のみを腹臥位とし，以後は側臥位を許可した。術後1～24か月（平均9か月）経過を観察した。結果：全例で円孔閉鎖と復位が得られ，早期退院が可能であった。1眼に円孔が再発し，最終的に10眼（91％）で治癒が得られた。術前と比較し，視力は70％で改善，30％で不変であった。合併症はなかった。結論：術後早期にガス液置換を行うことで黄斑円孔の治癒が得られ，短期的な患者の生活の質（QOL）を改善させることが可能である。

Abstract.　Background：Patients are stressed by prone position after macular hole surgery. A method is desired that ensures high success rate and shorter duration of prone position. Purpose：To report cases of macular hole surgery who received early gas-fluid exchange. Cases and Method：This retrospective study was made on 11 eyes of 11 cases of stage 3 macular hole. Their age averaged 66 years. Surgery was intended to create vitreous detachment only, followed by filling of vitreous cavity with C₃F₈. No peeling of internal limiting membrane was performed. Simultaneous cataract surgery was made on 10 eyes. Patiens remained in prone position on day 2 of surgery. They were allowed to take side-recumbent position after day 3. Cases were followed up for 1 to 24 months, average 9 months, after surgery. Results：Macular hole closed in all the eyes. Patients could leave the hospital soon after surgery. Macular hole recurred in one eye, resulting in final cure in 10 eyes（91％）. Visual acuity improved in 70％ of eyes and remained unchanged in 30％. There was no complication throughout the cases. Conclusion：Early gas-fluid exchange results in cure of macular hole and in improved quality of life of patients.