強度近視に伴う黄斑部網膜分離症に対する耳側強膜短縮術併用硝子体手術

Vitrectomy combined with scleral shortening for the treatment of myopic macular retinoschisis

要約　目的：近視性黄斑部網膜分離症（MMRS）に対する耳側強膜短縮術（SS）を併用した硝子体手術の治療成績を検討した。対象と方法：対象は，2012年1月～2013年4月に，耳側120°にわたる6mm幅のSSを併用し，内境界膜の意図的剝離をせずに後部ぶどう腫内の硝子体皮質剝離を行ったMMRSの連続症例10例10眼。術前術後の黄斑部OCT所見，視力を検討した。結果：3～15か月の術後経過観察期間で，10眼中9眼で解剖学的所見，4眼で矯正視力が改善した。OCT上，全例で後部ぶどう腫の軽度の平坦化が推察された。結論：本術式は奏効機序の解明が必要であるが，MMRS治療の選択肢として検討価値があると考えた。

Abstract.　Purpose：To report the outcome of vitrectomy combined with scleral shortening for the treatment of myopic macular retinoschisis. Cases and Methods：10 eyes of 10 patients with myopic macular retinoschisis underwent surgical treatment between January 2012 and April 2013. The surgery included scleral infolding of 6 mm width, the extent of which was 120 degree circumferentially, and pars plana vitrectomy with removal of vitreous cortex. Intentional removal of inner limiting membrane was not performed. Visual acuity and optical coherence tomography of macula was studied before and after the surgery during following up from 3 to 15 months. Results：Retinoschisis regressed anatomically in 9 eyes of 10 eyes. Visual acuity improved in 4 eyes. Tomographic images suggested slight flattening of posterior staphyloma in all 10 eyes. Conclusion：Although the mechanism remains unclear, vitrectomy combined with scleral shortening may be effective and may become a surgical alternative for the treatment of myopic macular retinoschisis.