Qスイッチ型Nd-YAGレーザーの網膜硝子体疾患への応用

Treatment of vitreoretinal disorders by Q-switched Nd-YAG laser

　種々の網膜硝子体疾患12例（13眼）に対し，Qスイッチ型Nd-YAGレーザーとPeyman硝子体用コンタクトレンズ，もしくはGoldmann　三面鏡を用い，硝子体索（膜），網膜フラップの切開を行った。硝子体索（膜）切開では10眼中9眼で成功したが，牽引性網膜剥離の症例において，広範囲の硝子体癒着を伴う前後方向の牽引に対しては，ほとんど無効であった。しかし，接線方向の牽引による黄斑偏位の症例では有効な結果が得られた。網膜裂孔の3眼では全てでフラップの切開が成功し，硝子体の牽引が解除された。合併症として，硝子体索内新生血管，網脈絡膜からの出血の危険性があり，慎重に症例を選択する必要がある。

We treated 13 eyes, 12 cases, of vitreoretinal disorders with Q-switched Nd-YAG laser (Coher-ent System 9900). We used Peyman or Goldmann three-mirror contact lens as a routine procedure. The energy output ranged from 3.0 to 12.0 mJ. Single pulse was used throughout. The number of bursts totalled 30 to 1,116, applied in 1 to 3 sessions, in the series.

dissection of vitreous strand or membrane was successful in 9 out of 10 eyes, of which clinically meaningful relief of vitreoretinal traction resultedin only 2 eyes: one eye with macular distortion by tangential vitreous traction and in another with a focal traction secondary to chorioretinitis.

As complication during laser treatment, 2 eyes developed hemorrhage from vessels in the vitreous strand. One eye developed hemorrhage from the detached retina during treatment.

Dissection of flap at the site of retinal tear was successful in 3 eyes, resulting in relief of vitreous traction to the retina. Choroidal hemorrhage devel-oped in 2 eyes during the treatment. The hemor-rhage disappeared in a week.

Nd-YAG laser is of value in treating vitreo-retinal disorders. Because of inherent risk of intraocular hemorrhage, due precaution is neces-sary in the selection of cases and in the actual procedure.