脈絡膜剥離を伴った裂孔原性網膜剥離

Rhegmatogenous retinal detachment associated with choroidal detachment

　裂孔原性網膜剥離が脈絡膜剥離を伴った場合，剥離手術を行うにあたって術前に長期の安静を行って脈絡膜剥離の消退を待って手術を行った従来の方法と，安静期間を長く取らないで早期手術を行う最近の方法とを比較した．いずれの場合もscleral buckling法を行うのを基本とし，最近は脈絡膜剥離が高度であるとchoroidal tapと硝子体内に液体ないし気体の注入を併用した．術前の安静期間は従来の方法では平均約12日，最近の方法では約4日であった．

　手術成績は，退院時の網膜復位率は両者に差はなく約90％であったが，6カ月後の成績は従来の方法では増殖性硝子体網膜症による剥離再発例があったため復位率83.3％となったが，最近の早期手術では復位率91.7％を保ち良い結果であった．長期安静と薬物療法で脈絡膜剥離の自然消退を待って手術をするよりも，脈絡膜剥離があっても手術を行い，もし高度であればchoroidal tapと，硝子体内液体ないし気体注入を併用すればよい．

　しかし1眼あたりの手術回数は，従来の方法は1.17回であったのに対し，最近の方法は1.33回，さらにchoroidal tapを行った例のみについては1.71回で，最近の方法では手術回数が多かった．

　Scleral buckling法が好成績であったのに対し，硝子体手術は成績が必ずしも良くなく，特別な症例を除き通常は適応はないと思われた．

We treated 45 eyes in 45 cases with rheg-matogenous retinal detachment associated with manifest choroidal detachment. These cases com-prised 3.5% of a consecutive series of 1,226 eyes operated for retinal detachment during the fore-going 88-month period. During the initial 4 years, surgery was performed after the choroidal detach-ment subsided with bedrest and medications. During the latter period of 3 years and 4 months, we perform-ed early surgery without waiting for resolution of choroidal detachment. Whenever necessary, we performed choroidal tap, or drainage of the supra-choroidal fluid, and vitreal injection of balanced salt solution and/or air.

We compared the two procedures. The duration of strict bedrest averaged 12 days in the former series and 4 days in the latter. The patients were discharged after an average of 1.17 surgeries in the former and 1.33 surgeries in the latter series. The rate of retinal reattachment at the time of discharge was 86% in the former and 92% in the latter series. Six months after surgery, the retina was attached in 83% and 92% in either series.

Our findings indicate that no practical advantage exists in waiting for resolution of choroidal detach-ment before surgery. Early surgery with choroidal tap seems to be the procedure of choice for retinal detachment with choroidal detachment.

Rinsho Ganka (Jpn J Cmn Ophthalmol) 41(6) : 591-595, 1987