巨大裂孔のための網膜縫合術その1手術手技

Retinopexy with suturing for retinal detachment with giant tear

　巨大裂孔による網膜剥離の治療の際，輪状締結術にガスを併用しても網膜が固定されないことが多い．このため巨大裂孔の断端を眼球壁に固定する方法が試みられている．我々は，網膜の断端を眼球壁に縫合する新しい方法を考案した．8-0ナイロン糸付の長さ2.8mm，太さ0.4mmのスキー状の両端針の一針を，closed vitrectomy後，幅1.4mmの毛様体偏平部の強膜創より挿入し，直視下に網膜を刺し通し，対側の眼球壁の適当な位置に刺出する．次いで第2針も同様の操作を行って，糸を眼球外，強膜上で縫合する．2症例にその方法を用い，2例とも網膜は復位した．

We successfully treated two eyes with retinal detach-ment with giant retinal tear consequent to blunt ocular trauma. The retinal tear was located along the equator, over an arc of 180° and 200° each. We employed a new, transvitreal suturing method using a 8-0 nylon thread with ski-shaped needles, 2.8 mm in length and 0.4 mm in diameter, at both ends.

Following closed vitrectomy, one of the needles was inserted through a scleral incision at the pars plana, 1.4mm in length, and was advanced under direct observation through the retinal flap. The needle was passed through the sclera at the opposite ocular wall.The second needle was also passed similarly to perfo-rate the sclera. The thread was tied over the sclera to bring the detached retina into apposition. The surgery was completed by scleral encircling and gas-fluid exchange in both cases. Within the limited scope of our experience, our sutur-ing technique promises to be of value in the treatment of retinal detachment with giant tear by securing retinal fixation because of its simple procedure and the absence of major complications.

Rinsho Ganka (Jpn J Clin Ophthalmol) 40(11) : 1267-1270,1986