裂孔原性網膜剝離手術に液体パーフルオロカーボンを使用し黄斑円孔が生じた1例

Macular hole formation during vitreous surgery for rhegmatogenous retinal detachment using liquid perfluorocarbon

要約　目的：裂孔原性網膜剝離（RRD）の手術中，液体パーフルオロカーボン（PFCL）を使用し，網膜下液（SRF）の移動中に黄斑円孔が生じた1例の報告。

症例：66歳女性。2週間前からの右眼の視力低下，網膜剝離のため当科を紹介され受診した。初診時の矯正視力は右眼0.04，眼底は硝子体出血と全網膜剝離を認めた。白内障併用硝子体手術を施行した。手術中PFCLでのSRF移動時に黄斑円孔を生じ，PFCLが網膜下に迷入した。意図的裂孔よりPFCLを吸引し，内境界膜剝離後にSF₆ガスを注入した。黄斑円孔は閉鎖が得られず，2週間後に再手術を施行し円孔は閉鎖した。初回治療15か月後の右眼矯正視力は0.4まで改善した。

結論：SRFの移動にPFCLを使用する場合，黄斑円孔を生じる危険がある。

Abstract　Purpose: To report a case who developed macular hole during vitreous surgery for rhegmatogenous retinal detachment using liquid perfluorocarbon.

Case: A 66-year-old female was referred to us for retinal detachment. She had impaired vision in the right eye since 2 weeks before. The right eye showed total retinal detachment with best corrected visual acuity of 0.04. The right eye was treated by vitreous and cataract surgery. Macular hole developed during attempted removal of subretinal fluid with intravitreal perfluorocarbon, Perfluorocarbon moved into the subretinal space through the macular hole. The eye was further treated by peeling of internal limiting membrane and intravitreal injection of sulfur hexachloride. Vitrectomy was performed another 2 weeks later. The right eye has been free of macular hole or retinal detachment with visual acuity of 0.4 for 15 months until present.

Conclusion: This case illustrates that macular hole may develop during attempted removal of subretinal fluid with intravitreally injected perfluorocarbon.