特発性老人性黄斑円孔に対する全周クリプトンレーザー凝固

Krypton laser photocoagulation around senile idiopathic macular hole

　3〜6週間前，急激に視力低下を来した特発性老人性黄斑円孔26眼に，黄斑円孔周辺の網膜隆起に沿って全周360°を赤色クリプトンレーザーで凝固した。56〜78歳の男6例，女14例，計20例の患者で，同年輩の健常者に比較して眼動脈圧が有意に高く，著明な起立性低下を示した。26眼中13眼に高度の後部硝子体剥離が証明され，他の13眼に黄斑部限局の硝子体収縮を否定できなかった。

　凝固前の矯正視力は0.02〜0.5,11眼では0.16またはそれ以上であった。凝固後3〜18ヵ月の経過観察で，矯正視力は18眼に改善，1眼に悪化，7眼に不変であった。視力改善は術後1〜2週間で起こり，患者も改善を自覚した。視力改善率（69％）は約10％とされる自然改善に比べて明らかに高率である。

I treated 26 eyes, 20 patients, with idiopathic senile macular hole by applying krypton red laser photocoagulation. The series included 6 males and 14 females. There was a large posterior vitreous detachment in 13 eyes. In the other 13 eyes, local-ized vitreous shrinkage affecting the macula was suspected. The best visual acuity before treatment was 0.02 to 0.1 in 15 eyes and 0.16 to 0.5 in 11 eyes. By ophthalmodynamometry, the ophthalmic arte-rial pressure was significantly higher than in age -matched healthy subjects. A pronounced orthos-tatic drop was also present.

As a standard pattern, photocoagulation was applied along the rim of the detached retina around the macular hole, with 200 μm spot size and the burns totalling 80 to 270. In the majority of cases, the treatment was followed by marked reduction of serous detachment within a few weeks. After a follow-up period of 3 to 18 months, the visual acuity improved in 18 eyes, remained stationary in 7 and deteriorated in 1. This rate of improvement was decidedly better than that of spontaneous reso-lution which is assumed to be around 10%.