網膜復位手術におけるヒアルロン酸の使用

Use of hyaluronic acid in retinal detachment surgery

　18例18眼の裂孔性網膜剥離（Grade C以上の増殖性硝子体網膜症の1眼を含む）の復位目的で，ヒアルロン酸製剤（ヒーロン^® ）を硝子体腔に0.5mlから4ml注入し，最低2年間経過観察した．注入圧によって網膜下液を強膜切開，脈絡膜穿刺部から排液し，ほぼ復位した後に網膜裂孔の冷凍凝固とシリコンスポンジエクソプラントを置いた．14眼が術翌日から復位したが，4眼は2週間から7カ月の長期間にわたって網膜下ヒーロン^® による扁平網膜剥離が残存した．硝子体の濃縮と索形成が9眼にみられ，うち3眼に網膜剥離が再発し，再手術が必要となったが，いずれも再手術により復位した．術前に増殖性硝子体網膜症C1であった1眼は術後1カ月してD1となり，結局復位をえられなかった．黄斑部皺襞形成が2眼に生じた．これらはヒアルロン酸が増殖性変化を促進する可能性を示唆している．術後1〜4週に軽度の眼圧上昇が4眼にみられたが，1週間で正常化した．

Pars plana injection of hyaluronic acid (Healon^® ) ) was performed intravitreally to induce hydrautic release of subretinal fluid through the sclerotomized site. Reattached retinal breaks were treated by cryo-retinopexy and buckling procedure with explant. The amount of injected hyluronic acid ranged from 0.5 to 4.0 ml. The surgery was a success in all the eyes but one : the retina was in reattached state 2 years after surgery in 17 eyes. Only one eye, which was in a state of Cl proliferative vitreoretinopathy at the time of surgery, developed into D1 after surgery.developed into D1 after surgery. A residual flat detach-ment persisted for 2 weeks to 7 months after surgery in 4 eyes. The residual detachment seemed to be the consequence of introduction of hyluronic acid into the subretinal space during surgery. Condensation of the vitreous and strand formation occurred in 9 eyes, of which 3 eyes developed retinal redetachment 1 week, 2 weeks and 2 years after surgery. Macular pucker devel-oped in 2 eyes. An intraocular pressure elevation to maximally 40 mmHg occurred in 4 eyes 1 to 4 weeks after surgery. The intraocular pressure returned to normal level within 1 weeks. The findings indicate that intravitreous injection of hyaluronic acid does not seem to drastically facilitate retinal detachment surgery in general.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(2) : 125-128, 1987