増殖性硝子体網膜症に対する硝子体手術ガスタンポナーデの成績

Results of vitreous surgery with air/gas tamponade for selected cases of proliferative vitreoretinopathy

　増殖性硝子体網膜症17例17眼の復位手術として，硝子体切除増殖膜除去，気圧伸展網膜復位，輪状締結，網膜裂孔の眼内キセノン光凝固，空気またはSF₆ガスタンポナーデを施行した。前部網膜の肥厚と短縮がなく，気圧伸展網膜復位が完全なものをガスタンポナーデの適応とし，気圧伸展網膜復位が迅速で完全であった9眼は空気タンポナーデ，遅延するが完全であった8眼はSF₆ガスタンポナーデとした。17眼のうち14眼，82％が復位した。

Selected cases of rhegmatogenous retinal detach-ment complicated with proliferative vitreoretino-pathy (PVR) were treated by vitreous surgery with additional air or gas tamponade with SF₆. Only such cases were subjected to the present evaluation in which the detached retina was completely reatta-ched by pneumatic reattachment procedure and the peripheral retina was not thickened nor contracted anteriorly after meticulous removal of preretinal proliferative tissue. The present series included, after the PVR grading, 1 C1 eye, 6 C2 eyes, 5 C3 eyes, 3 D1 eyes, 1 D2 eye and 1 D3 eye. As surgical procedures, I employed vitrectomy using three-port Oculome II, membrane peeling and delamination,pneumatic retinal reattachment with internal drain-age, xenon endophotocoagulation for retinal breaks and if necessary, scattered photocoagulation, encir-cling procedure to produce a low buckle located anteriorly, and tamponade with air or SF₆. Air was used when prior pneumatic retinal reattachment was rapid, and when delayed, gas was the method of choice.

In the present series of 17 eyes, the retina remained attached in 13 eyes (76%) without serious complications at the end of follow-up of 12 months or more. The present surgical approach and the principle of selection of cases are judged as appro-priate because of the high rate of success.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(11) : 1242-1244,1987