Proliferative vitreoretinopathy手術におけるbuckleの役割

The significance of scleral buckling in surgical management of proliferative vitreoretinopathy (PVR)

　Membrane peeling手技を用いて手術した赤道部裂孔によるproliferativevitreoretinopathy （PVR）においてのbuckleの役割の評価をするため，自験対象例を2群に分け検討した．硝子体手術単独群8例8眼は既存のbuckleには手をつけず，裂孔閉鎖を眼内冷凍凝固とair tamponadeのみで行った．一方，Buckle併用群14例14眼は硝子体手術と同時に裂孔閉鎖のためのbuckleとencirclingを確実なものに置き換えたものである．硝子体手術単独群8眼のうち復位は1眼のみ（治癒率13％），であり，7眼はairが抜けると再剥離した．裂孔周辺側の牽引が取りきれなかったためと考えられる．それに対して，buckle併用群の14眼では9眼が復位し（治癒率64％），非復位例は裂孔不明など5眼であった．赤道部裂孔によるPVRにおいては，硝子体側からの牽引をvitrectomy単独で除去できる保証はなく，強膜側からのbuckleによる牽引除去は治癒に導く不可欠の要素と考えられた．

We treated 22 eyes with rhegmatogenous retinal detachment complicated by proliferative vitreoret-inopathy (PVR) during the foregoing 33 months. Previous surgery had been performed in 17 eyes. The retinal break was located in the equatorial region in all the eyes.

We treated the eyes with either of the two ap-proaches. In the first group of 8 eyes, vitrectomy and membrane peeling was performed with endocryo-cautery and air tamponade without correcting the preplaced scleral buckle. In the second group of 14 eyes, vitrectomy was performed with readjustment of preplaced scleral buckle and by scleral encircling.Lasting retinal reattachment resulted in one eye (13%) in the first group and in 9(64%) in the second. In the first group, retinal detachment recurred along with disappearance of air in the vitreous.cavity. The early recurrence of retinal detachment was thus thought to be due to insufficient closure of the retinal break and incomplete release of vitreous traction.

In eyes with PVR and retinal break in the equa-tor, it was technically impossible to completely release the vireous traction by vitrectomy alone, so that an effective scleral buckling is essential in in-ducing sufficient relaxation of vitreous traction and reattachment of the retina.