網膜光凝固を行った未熟児網膜症の臨床像と治療成績

Clinical features and outcome of retinopathy of prematurity treated by photocoagulation

要約　目的：網膜光凝固で治療した未熟児網膜症（ROP）の臨床像と結果の報告。

対象と症例：過去3年間にROPに対して光凝固を行った23例44眼を対象とした。出生時の平均体重は796±291g，在胎期間は26.4±22週であった。治療時の網膜症の活動期分類は，zone Ⅱ stage 3＋とstage 2＋が28眼（64％），zone Ⅰ stage 3が1眼（2％），aggressive posterior ROPが4眼（9％），zone Ⅱ stage 3が11眼（25％）であった。光凝固は双眼倒像鏡下で行い，約90％の症例では眼底に瘢痕は生じなかった。

結果：網膜症は41眼（93％）で鎮静化し，3眼（7％）に網膜剝離が生じた。最終時の観察で，39眼（89％）が瘢痕期分類1度，5眼（11％）が2度弱度であった。3歳まで追跡した7例12眼では，平均視力（logMAR）が0.36，等価球面度数が−0.88Dであった。

結論：網膜光凝固で治療したROPの3歳までの経過は，瘢痕化が軽度であり，近視化も少なかった。

Abstract　Purpose：To report clinical features and outcome of retinopathy of prematurity（ROP）treated by photocoagulation.

Cases and Method：This retrospective study was made on 44 eyes of 23 cases who received photocoagulation for ROP. Their birthweight averaged 796±291 g after gestation of 26.4±22 weeks. ROP at the time of photocoagulation was zone Ⅱ stage 2＋ or stage 3＋ in 28 eyes（67％）, zone Ⅰ stage 3 in one eye（2％）, aggressive posterior in 4 eyes（8％）, and zone Ⅱ stage 3 in 11 eyes（25％）. Photocoagulation was performed under binocular indirect ophthalmoscopy. No coagulation spot or scar appeared in about 90％ of eyes.

Results：ROP subsided in 41 eyes（93％）. Retinal detachment developed in 3 eyes（7％）. At the last session of follow-up, 39 eyes（89％）were in scarring stage 1 and 5 eyes（11％）were in scarring stage 2. In 12 eyes of 7 patients who were followed up until 3 years of age, visual acuity averaged 0.36 logMAR. Refraction averaged −0.88 diopters.

Conclusion：Eyes with ROP treated by photocoagulation showed minor anatomical lesions without notable refraction errors up to 3 years of age.