網膜分枝静脈閉塞症に続発した網膜裂孔と裂孔原性網膜剥離

Retinal Tear and rhegmatogenous retinal detachment secondary to branch retinal vein occlusion

　網膜分枝静脈閉塞症の晩期合併症として発生した網膜裂孔と裂孔原性網膜剥離の9例9眼について検討した．この合併症は分枝静脈閉塞症の4％にみられ，いずれも陳旧性の分枝静脈閉塞症に合併したものであった．網膜裂孔はすべて眼底の中間部に発生し，その成因は，円孔と楕円孔には網膜の虚血が，細隙状および馬蹄型裂孔にはそのほかに硝子体の牽引も関与していた．治療には，裂孔だけの例や網膜剥離が裂孔周囲にのみ限局している例は光凝固が有効で，高度な網膜剥離例ではscleral buckling法がよく，著明な硝子体出血を伴わない限り硝子体手術の適応はない．また無血管野と新生血管に対し光凝固を加えておくのがよい．予後は良好である．網膜の虚血が著しい分枝静脈閉塞症は裂孔が形成される前に光凝固で予防しておく必要がある．

We observed 9 eyes in which retinal tear was formed as a complication of inveterate branch retinal vein occlusion (BRVO). Rhegmatogenous retinal detachment developed in 7 of these eyes.

Retinal tear was located in the nonperfused area affected by BRVO and usually in the midperipheral retina. The tear was either round, oval, slit-like or horseshoe-shaped. Round or oval tears lacked oper-culum or flap. Vitreous traction was absent. Retinal ischemia seemed to be the chief underlying cause for these tears. Slit-like and horseshoe-shaped tears were located adjacent to occluded vessels. Neovas-cular fibrotic tuft adhered to the posterior vitreous. These tears seemed to be formed by vitreoretinaltraction in addition to ischemic retinal atrophy and degeneration.

Photocoagulation was effective for cases with retinal tear alone or with localized flat retinal detachment. Cases with manifest retinal detach-ment were treated by conventional surgical methods. We performed supplemental photo-coagulation over the whole nonperfused retina and to newly formed vessels to avoid recurrence of vitreous hemorrhage. One case needed vitrectomy after initial buckling procedure. The therapeutic outcome was excellent in all the eyes. We advocate prophylactic photocoagulation to all eyes with is-chemic type of BRVO before retinal tear is formed.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(8) : 1037-1044, 1987