自然閉鎖した後に再発したstage 4特発性黄斑円孔の1例

Recurrence of stage 4 idiopathic macular hole after spontaneous closure

要約　目的：特発性黄斑円孔の自然閉鎖は稀であり，3〜5％と報告されているが，再発した症例の報告は数例のみである。今回，特発性黄斑円孔が自然閉鎖した後に再発した1例を経験したので報告する。

症例：手術時65歳，男性。右眼視力低下と歪視を主訴に近医を受診し，右眼黄斑円孔を指摘され，手術目的で紹介となる。初診時の右眼視力は（0.5），stage 4特発性黄斑円孔を認め，手術予定となったが，その後自然閉鎖し，手術せずに経過観察となった。右眼視力（1.2）まで改善したが，3年後に右眼視力は（0.2）へと低下し，stage 4特発性黄斑円孔の再発を認めた。白内障および硝子体同時手術を行い，内境界膜剝離と六フッ化硫黄ガスタンポナーデを併施した。術翌日，円孔閉鎖を認め，術後6か月の右眼視力は（0.4）であった。

結論：特発性黄斑円孔の自然閉鎖後に再発した例は稀であるが，自然閉鎖後も経過観察が必要と考えられた。

Abstract　Purpose：Spontaneous closure of full-thickness macular hole is uncommon, but it has been observed in 3％ to 5％ of a macular hole series. There have been several reports of recurrence of idiopathic macular hole after spontaneous closure. Herein, we report a case of recurrence of idiopathic macular hole after spontaneous closure.

Case：A 65-year-old man was referred to us for metamorphosia of his right eye with corrected visual acuity of 0.5. He was diagnosed as having a stage 4 idiopathic macular hole. We intended to treat the macular hole using pars plana vitrectomy；however, it had closed spontaneously with improvement in visual acuity to 1.2. Three years later, the macular hole reopened with reduction in visual acuity to 0.2. We performed pars plana vitrectomy with internal limiting membrane peeling and gas tamponade, combined with phacoemulsification and intraocular lens implantation. After the surgery, the macular hole had closed, and it has not reopened since. Visual acuity had improved to 0.4 at 6 months after surgery.

Conclusion：We recommend careful follow-up of patients in whom an idiopathic macular hole closes spontaneously.