硝子体内シリコン注入症例の検討

Evaluation of intravitreal liquid silicone surgery

　当科でシリコンオイル（以下SO）を注入した最近の23眼について手術成績，臨床経過，合併症を検討した．

　原疾患は増殖性硝子体網膜症（PVR）を伴った裂孔原性網膜剥離18眼，外傷性牽引性網膜剥離4眼，増殖性糖尿病性網膜症1眼である．術後6カ月で23眼中14眼（61％）に視力向上を認め0.1以上は8眼であった．退院時に復位を認めたもの15眼，部分剥離6眼，全剥離2眼であった．術後6カ月後に復位を保っていたのは15眼中10眼で，そのうち5眼にSOの抜去を行った．抜去後3眼に再剥離をみた．復位15眼のうち再剥離を来したのは5眼で網膜上膜，網膜下の増殖を伴っており2眼は牽引除去，SOの再注入により復位を得た．退院時部分剥離の6眼中5眼は6カ月後も剥離状態は変化はなかった．術後6カ月での合併症は白内障6眼，緑内障3眼であった．SO注入後の再剥離，SO抜去，合併症の問題点について検討した．

We evaluated a series of 23 eyes treated by intravitreal silicone oil injection. These cases are from a larger series of 53 eyes treated by intravitreal silicone during a 4-year period through 1960. The present series included 18 eyes with rheg-matogenous retinal detachment complicated by proliferative vitreoretinopathy (PVR), 4 eyes with traumatic retinal detachment and 1 eye with proliferative diabetic retinopathy.

When seen 6 months after surgery, 14 eyes (61%) showed improved visual acuity. The postoperative visual acuity was 0.1 or better in 8 eyes. Anatomical reattachment of the retina was obtained in 15 eyes (65%) at the time of discharge from our hospital. The retina remained still attached in 10 eyes at 6 months after surgery. Removal of silicone oil was performed in 5 of these 10 eyes. Tractional retinal detachment developed in 3 of the 5 eyes.

In the 5 eyes which retinal detachment recurred following initial success, the recurrence was due toprogressive epiretinal and subretinal proliferation. We treated 3 out of the 5 eyes with intravitreal silicone implant again, which proved successful in 2 eyes (66%).

At 6 months after surgery, 6 out of the 23 eyes developed cataract and 3 developed glaucoma. It appeared that the glaucoma could have been avoid-ed by placing peripheral iridectomy at 6 o'clock position.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(6) : 607-610, 1987