特発性黄斑円孔の日帰り硝子体手術

Vitreous surgery on an outpatient basis for idiopathic macular holes

要約　目的：特発性黄斑円孔に対し，外来で日帰り硝子体手術を行った結果の報告。対象と方法：過去3年間に同一術者が手術した22例22眼を対象とした。男性6眼，女性16眼で，年齢は49～80歳（平均66歳）である。推定罹病期間は0.5～24か月，平均4.7か月であった。全例が全層黄斑円孔で，Gass分類では5眼が第2期，17眼が第3期であった。60歳以上の症例には白内障手術，全例に単純硝子体切除，後部硝子体剝離，無染色内境界膜剝離，空気タンポナーデを行った。術後約9時間は腹臥位，以後は仰臥位以外は自由な体位とした。視力はlogMARで評価した。結果：全例が初回手術で円孔が閉鎖した。視力は術前に比べ術後1か月以降で有意に改善し，術後18か月後の小数換算視力は平均1.01であった。合併症はなかった。結論：特発性黄斑円孔に対し，外来日帰り手術でも良好な結果が得られた。

Abstract.　Purpose：To report the outcome of vitreous surgery for idiopathic macular hole on an outpatient basis. Cases：This retrospective study was made on consecutive series of 22 eyes of 22 patients who received surgery for full-thickness macular hole by a single surgeon in the past 3 years. The series comprised 6 males and 16 females. The age ranged from 49 to 80 years,average 66 years. The estimated interval from onset to surgery ranged from 2 weeks to 24 months,average 4.7 months. The macular hole was classified as stage 2 in 5 eyes and as stage 3 in 17 eyes after Gass. Method：Cases over 60 years of age received lensectomy. All eyes received simple vitrectomy,separation of posterior vitreous,peeling of internal limiting membrane without staining,and air tamponade. Patients were to remain in face-down position for 9 hours,to be followed by any position except supine one. Visual acuity was evaluated as logMAR. Results：Macular hole closed in all the eyes after single surgery. Visual acuity started to improve from one month until 18 months after surgery. There was no complication throughout. Conclusion：Day surgery on outpatient basis was effective for idiopathic full-thickness macular hole.