裂孔原性網膜剝離に対するシャンデリア照明を併用した網膜復位術の検討

Review of scleral buckling surgery with chandelier illumination for rhegmatogenous retinal detachment

要約　目的：広角観察システムとシャンデリア照明を用いた網膜復位術の有用性の検討。

対象と方法：長崎大学眼科で施行された強膜内陥術について，シャンデリア照明併用部分強膜内陥術，輪状締結術，シャンデリア照明非併用部分強膜内陥術，輪状締結術に分類し後ろ向きに検討した。

結果：初回の網膜復位率に有意差はなかった。手術時間は有意にシャンデリア照明併用群のほうが短かった。術後に角膜上皮障害があった症例はシャンデリア照明併用群で有意に少なかった。

結論：シャンデリア照明併用網膜復位術は，復位率は同等で手術時間は短縮され角膜上皮障害は少なかった。ただし，水晶体への接触や硝子体内への感染については注意が必要である。

Abstract　Purpose：To present a review of wide-angle viewing system and chandelier illumination for rhegmatogenous retinal detachment.

Cases and Method：This retrospective study was made on 195 eyes that received scleral buckling surgery in the past 7 years. Surgery was performed either by standard or chandelier illumination.

Results：The retina became reattached after initial surgery in 33 out of 37 eyes（89％）after chandelier-assisted segmental buckling, 29 out of 33 eyes（88％）after standard segmental buckling, 20 out of 23 eyes（87％）after chandelier-assisted scleral encircling, and 32 out of 37 eyes（87％）after standard scleral encircling. The differences were not significant. Duration of surgery was significantly shorter in chandelier-assisted than standard segmental buckling（p＝0.045）, and shorter in chandelier-assisted than standard scleral encircling（p＝0.007）.

Conclusion：Chandelier-assisted scleral buckling reduced the duration of surgery by allowing the retinal break easier to find. Diathermy with light illumination assisted the correct location of retinal break on the sclera. Careful management of the chandelier was necessary to avoid touching the lens or causing infection in the vitreous.