Nd-YAGレーザーによる外傷性黄斑円孔の1例

A case of traumatic macular hole induced by Nd-YAG laser

要約　目的：Nd-YAGレーザーによる外傷性黄斑円孔に対し，内境界膜剝離が奏効した症例の報告。

症例：22歳の男性が，大学院生として研究中にNd-YAGレーザーの反射光が右眼に入り，その直後から視力低下と中心暗点を自覚した。受傷2日後に受診したときの右眼の矯正視力は0.7で，黄斑に接する部位の白濁と出血があった。光干渉断層計で黄斑の断裂があった。自然閉鎖を期待したが，全層の黄斑円孔が拡大し，中心暗点が増悪したので，10週後に硝子体手術を行い，内境界膜を剝離し，硝子体を20％ SF₆ガスで置換した。黄斑円孔は閉鎖し，矯正視力は1.2に改善した。以後6か月後の現在まで，黄斑円孔の再発はなく，視力にも変化がない。

結論：Nd-YAGレーザーによる外傷性黄斑円孔に対し，硝子体手術と内境界膜剝離が奏効した。

Abstract　Purpose: To report a case of traumatic macular hole induced by Nd-YAG laser and treated by peeling of internal limiting membrane.

Case: A 22-year-old male student was referred to us for impaired vision and central scotoma. His right eye was accidentally exposed by Nd-YAG laser two days before.

Findings: Corrected visual acuity was 0.7 right. The right fundus showed turbid area and hemorrhage adjacent to the nasal side of fovea. Optical coherence tomography（OCT）showed dehiscence of the fovea. The lesion developed into complete macular hole with marked increase in central scotoma. The right eye received, 10 weeks later, vitreous surgery with peeling of internal membrane. The vitreous was replaced by 20％ SF₆ gas. Surgery was followed by closure of macular hole. Visual acuity improved to 1.2. There has been no recurrence of macular hole or changes in visual acuity for 6 months until present.

Conclusion: Vitreous surgery with peeling of internal limiting membrane was effective for traumatic macular hole induced by Nd-YAG laser.