強膜マッサージが小切開硝子体手術における強膜創の自己閉鎖率に与える影響

Influence of scleral massage on self-sealing rate of sclerotomy in microincision vitreous surgery

要約　目的：23ゲージ小切開硝子体手術（MIVS）の創口自己閉鎖の検討。対象と方法：当院で23ゲージMIVSを施行した97例98眼。自己閉鎖にこだわらず強膜マッサージを数回のみ行ったA群71例72眼，自己閉鎖にこだわり十分な強膜マッサージを行ったB群27例27眼に分けた。両群とも強膜マッサージにて自己閉鎖しなかった場合，強膜創を縫合した。結果：自己閉鎖率はA群18.3％，B群93.8％で，B群が有意に高かった（p＜0.05）。B群内で強膜マッサージ時間を比較すると，灌流用創口で10時および2時創口より有意に短かったものの，10時および2時創口間では有意差がなかった。術後低眼圧はなかった。結論：十分に時間をかけた強膜マッサージは自己閉鎖に有用な手技と考えられる。

Abstract.　Purpose：To report the rate of self-sealing of sclerotomy in microincision vitreous surgery with or without sufficient scleral massage. Cases and Method：This study was made on 98 eyes of rhegmatogenous retinal detachment treated by microincision vitreous surgery in the past 25 months. The initial 71 eyes received nominal scleral massage at the end of surgery. The latter 27 eyes received sufficient scleral massage. Suturing was added whenever necessary. Results：The sclerotomy closed spontaneously in 18.3％ of sites after nominal scieral massage and in 93.8％ after sufficient scleral massage. The difference was significant（p＜0.05）. Duration of scleral massage in the latter 27 eyes was significantly shorter at the site of infusion cannule in the inferotemporal quadrant than that in superior quadrants（p＜0.05）. There was no difference in the duration between superior nasal and temporal quadrants. Postoperative hypotony was absent throughout. Conclusion：Sufficient scleral massage resulted in higher rate of self-sealing of sclerotomy in microincision vitreous surgery.