網膜剥離を伴った黄斑円孔の簡易手術法とその長期経過観察

Technique and long-term results of a simple surgery for retinal detachment with macular hole

　黄斑円孔を伴った網膜剥離16症例（女14例，男2例）に対して既報した簡易法を用いて手術を行った．症例はいずれも黄斑円孔以外の網膜裂孔はなく，明確な網膜硝子体癒着が後極部にみられない症例である．黄斑バックル，黄斑ジアテルミー，硝子体切除はいずれも行わず，眼圧を下げ，ガスあるいは空気を硝子体中に注入し，術後患者に腹臥位を命じた．眼圧を下げるのに網膜下液の多い症例では耳側の強膜側より下液を排除し，網膜下液が少ない症例には前房水を吸引した．

　16症例中14例でこの簡易法のみにより復位が得られ，3カ月から2年5カ月（平均13カ月）の経過観察中に網膜剥離の再発をみた例はない．

　本法は手術手技が容易で，眼球侵襲が極めて少なく，また黄斑部機能を障害しない．黄斑円孔を伴った網膜剥離のかなりの症例で第一選択術式となりうる．

We treated a consecutive series of 16 eyes with rheg-matogenous retinal detachment due to macular hole with the following methods during the past 27-month period. All the eyes were apparently free of posterior vitreoretinal connections.

In 10 eyes with extensive retinal detachment, we released the subretinal fluid transsclerally in the tempo-ral sector. Thereafter, either air or SF₆ gas, 1.0 ml or more in volume, was injected through the pars plana into the vitreous cavity. In other 6 eyes with localized retinal detachment in the posterior fundus, SF6 gas, 0.8 or more in volume, was injected into the vitreous after tapping the anterior chamber. We employed neither vitrectomy, scleral buckle nor diathermy to the macula. Postoperatively, the patients were kept in prone posi-tion for about 6 hours a day until disappearance of the air or gas in the vitreous cavity.

The retina remained as reattached in 14 out of the 16 thus treated eyes during the post-operative follow-up period ranging from 3 to 29 months (average 13 months). This surgical approach is effective, safe and does not require sophisticated instrumentations. Fur-ther, the macula is not damaged as in diathermy or buckling procedures. This procedure is recommended as the treatment of choice in eyes with retinal detachment due to macular hole provided no other retinal breaks or visible vitreous adhesion are present.

Rinsho Ganka (Jpn J Clin Ophthalmol) 40(2) : 101-106, 1986