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不明裂孔による下方の残存網膜剥離症例13眼(糖尿病性網膜症は対象から除外した)に対して,下方半周網膜切開による治療を試みた.13眼は以前に網膜硝子体手術(ガスタンポナーデや光凝固治療を除く)を数回(平均2.5回)施行したが再剥離してきた難治例であった.網膜切開は平均204度におよびシリコンオイルは12眼に併用した.12眼中シリコンオイル抜去が可能であったのは10眼で,抜去時期は網膜切開術後平均7.9カ月目であった.抜去後平均4.9カ月の経過観察中には全例再剥離はみられなかった.2眼は前房内にシリコンオイルが充満していたり,10mmHg以下の低眼圧である等の理由によりシリコンオイルを抜去できなかった.シリコンオイル抜去不能例の2眼を除く11眼(84.6%)に完全復位を得,最終的には,13眼中9眼(69.2%)に2段階以上の視力改善を得た.不明裂孔による下方残存網膜剥離に対して,下方半周網膜切開術は有効な方法と思われる.
We successfully treated 13 eyes with residual inferior retinal detachment by inferior semicircular retinotomy. The series included proliferative vitreoretinopathy 4 eyes, rhegmatogenous retinal detachment 7 eyes and traumatic retinal detach-ment 2 eyes. All the eyes had been treated by an average of 2.5 surgeries with unfavorable outcome. Ten eyes were aphakic. Prior vitreous surgery had been performed in 10 eyes. Silicone oil was present in the vitreous cavity in 6 eyes.
Inferior semicircular retinotomy extended over an average of 204 degrees. Additional silicone oil injection was employed in 12 eyes. Removal of silicone oil was performed in 10 eyes after an average of 7.9 months. Removal was not indicated in 2 eyes due to ocular hypotension or silicone oil filling in the anterior chamber.
The retina was reattached in all the eyes when evaluated 4.9 months after silicone oil removal. Improvement in visual acuity by 2 lines or more resulted in 9 out of 13 eyes (69%).
Rinsho Ganka (Jpn J Clin Ophthalmol) 42(12) : 1367-1371, 1988
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