硝子体手術直後に円孔閉鎖が得られず術後3か月に円孔閉鎖が確認された黄斑円孔の1例

Closure of idiopathic macular hole only three months after vitreous surgery

要約　目的：硝子体手術の直後には円孔の閉鎖が得られず，3か月後に円孔閉鎖が確認された1例の報告。

症例と経過：69歳女性が2か月前からの左眼視力低下で受診した。左眼の矯正視力は0.1であった。左眼眼底にstage Ⅳの黄斑円孔があり，最小円孔径は467μm，円孔底径は947μmであった。その1週間後に水晶体再建術と経毛様体扁平部硝子体手術を行い，2乳頭径の内境界膜を剝離した。術後3日間のうつ伏せをした。術後5日目の光干渉断層計（OCT）で円孔は非閉鎖であり，1か月後も同様であった。3か月後のOCTで円孔は閉鎖していた。視力は0.15であった。術前と比較し，術後1か月では黄斑の耳側網膜が50μm鼻側に移動し，3か月ではさらに31μm移動していた。

結論：術後3か月で円孔が閉鎖した要因として，内境界膜剝離による網膜の鼻側移動が関係している可能性がある。

Abstract　Purpose：To report a case of idiopathic macular hole that closed only 3 months after vitreous surgery.

Case：A 69-year-old female presented with poor visual acuity in the left eye since 2 months before.

Findings and Clinical Course：Corrected visual acuity in her left eye was 0.1. The left eye showed stage Ⅳ macular hole. Its diameter was 467 μm at its surface and 947 μm at its bottom. The left eye received lens reconstruction and pars plana vitreous surgery. Internal limiting membrane was peeled 2 disc diameters across. She remained in prone position for 3 days. Macular hole was still present when seen by optical coherence tomography 5 days after surgery. Similar finding was present one month after surgery. Macular hole was found closed when seen by OCT 3 months after surgery with visual acuity of 0.15. The retina temporal to the macular hole was nasally displaced by 50 μm one month after surgery and by further 31 μm three months after surgery when compared to the finding before surgery.

Conclusion：Nasal displacement of the retina after surgery may have been one of the reasons for closure of macular hole only after 3 months after surgery.