ガス注入による黄斑裂孔網膜剥離の治療

Treatment of retinal detachment with macular hole by intravitreal SF6

　黄斑裂孔網膜剥離に対して，SF₆ガスの硝子体腔内への注入のみによる治療を行った．対象は9例10眼で，増殖性硝子体綱膜症や硝子体牽引のない例に限った．100％のSF₆ガスを毛様体扁平部より約0.75ml注入し，眼圧上昇例には前房穿刺にて眼圧を低下させ，術後face down posi-tionをとらせた．10眼中8眼が復位したが，1眼は6カ月後に再剥離し，再度のガス注入にて復位した．復位しなかった2眼のうち1眼は黄斑バックル，1眼は硝子体切除と空気タンポナーデおよび眼内レーザー光凝固にて手術を行い，最終的には全例の復位に成功した．

　硝子体切除を行わずに，ガス注入のみによる黄斑裂孔網膜剥離の治療は，手術手技も容易で合併症も少ない．また，手術侵襲も極めて少ないため，今後第一選択となるべき手術方法と思われた．

We treated 10 consecutive eyes with rhegmatogenous retinal detachment due to macular hole by injectingsulfer hexafluoride gas (SF₆) into the vitreous. All the eyes were free of proliferative vitreoretinopathy or vitreous traction to the macula at the time of surgery.

As a standard procedure, 0.75 ml of pure SF₆ gas was injected through the pars plana into the vitreous cavity. Occasionally, the anterior chamber was tapped to relieve ocular hypertension. The patient was kept in face-down position during the postoperative period.

The retina was reattached in 8 eyes. Retinal detach-ment recurred in one of these 8 eyes 6 months later. It was brought to cure by another procedure with intravitreal gas. The other 2 eyes were successfully treated either by submacular sclera] buckling or combi-nation of vitrectomy, endolaser and intravitreal air tamponade.

Intravitreal gas injection without vitrectomy is a simple procedure and is free of serious complications. This procedure seems to be the treatment of choice for retinal detachment due to macular hole.

Rinsho Ganka (Jpn J Clin Ophthalmol) 40(2) : 107-111, 1986