黄斑部疾患に対する硝子体白内障同時手術での術後屈折誤差の検討

Refractive error following phacovitrectomy for macular diseases

要約　目的：白内障単独手術で挿入すべきIOLを硝子体白内障同時手術で挿入すると屈折誤差が生じる可能性がある。そこで，硝子体白内障同時手術において予測屈折値と術後屈折値を比較し，その誤差を検討した。

対象と方法：対象は特発性黄斑円孔（MH）と特発性黄斑上膜（ERM）に対し硝子体白内障同時手術を施行した111眼。MHは55眼，ERMは56眼で，白内障のみ施行した50眼を対照とした。超音波Aモード法（Aモード）または光学式眼軸長測定装置（IOLマスター）にて眼軸長測定，IOL度数決定を行い，予測屈折値と術後屈折値の誤差をレトロスペクティブに検討した。

結果：3疾患すべて近視寄りの屈折誤差を認め，Aモード群でMHはERMと白内障より，IOLマスター群でMHとERMは白内障より有意に屈折誤差が大きかった。

結論：今後さらなる硝子体白内障同時手術の増加が予想され，硝子体白内障同時手術を行う際には術後の屈折誤差を考慮したIOL度数決定が必要であると考えられた。

Abstract　Purpose：To report the outcome regarding refractive error after phacovitrectomy in eyes with macular diseases.

Cases and Method：This study was made on 111 eyes of 105 cases who received phacovitrectomy. The series comprised 44 male and 67 female eyes. The age averaged 67.7±7.5 years. Surgery was performed for macular hole in 55 eyes and for epiretinal membrane in 56 eyes. Another series of 50 eyes that received cataract surgery only served as control. Axial length was measured by ultrasound or laser interference biometry（IOL Master^TM）. Refractive errors after surgery were retrospectively examined.

Results：All the three groups showed postoperative shift to myopia than the predicted value. The errors were significantly greater in eyes with macular hole than eyes with epiretinal membrane or control when measured by ultrasound. The errors were greater in eyes with macular hole and epiretinal membrane than control when measured by IOL Master^TM.

Conclusion：The present cases show the need of determination of IOL power that predicts the refraction after phacovitrectomy.