岐阜大学医学部附属病院にて硝子体手術を施行した外傷性黄斑円孔の3例

Three cases of traumatic macular hole treated by vitreous surgery

要約　目的：硝子体手術を行った外傷性黄斑円孔3例3眼の報告。

症例：3例はすべて男性で，年齢はそれぞれ，12歳，19歳，22歳であった。外傷の原因は，1例は自転車荷台用のゴム紐先端の金属による左眼の打撲，他の2例は軟式野球の自打球による打撲であった。

所見と経過：初診時の患眼の視力は，それぞれ0.08，手動弁，0.3であり，それぞれ受傷眼に黄斑円孔があった。それぞれ受傷から14週，10日，24日後に硝子体手術を行った。1例では円孔周囲の内境界膜剝離，他の2例では内境界膜翻転を併用した。円孔は1例では閉鎖せず，他の2例では閉鎖した。最終視力は，それぞれ0.1，0.03，1.0であった。

結論：外傷性黄斑円孔に対する硝子体手術で，円孔周囲の内境界膜の剝離または翻転を行った。最終視力には，受傷の状況，円孔の大きさ，手術の時期，黄斑円孔に併発した網脈絡膜萎縮などが関係するので，これらを考慮した術式が望まれる。

Abstract　Purpose: To report 3 cases of traumatic macular hole treated by vitreous surgery.

Cases: All were males and were unilaterally affected. They were aged 12, 19 and 22 years respectively. Blunt trauma to the eye was due to a metal tip of rubber cord attached to bicycle in one case and due to flying rubber ball while playing baseball as a batter in the other two cases.

Findings and Clinical Course: Initial corrected visual acuity was 0.08, hand motion, and 0.3 respectively in the injured eye. All the 3 eyes showed macular hole. Vitreous surgery was performed 14 weeks, 10 days, and 24 days respectively after injury. One eye received additional peeling of internal limiting membrane（ILM）around the macular hole. Two eyes received ILM flap technique. Macular hole failed to close in one case and closed in the other 2 cases. Final visual acuity was 0.1, 0.03, and 1.0 respectively.

Conclusion: The present cases show that outcome of macular hole surgery may depend on the cause of injury, size of macular hole, timing of surgical intervention, and associated retinochoroidal atrophy.