網膜外層欠損を伴う中心窩剝離に対する硝子体手術を行った2例

Two cases of vitrectomy for macular detachment with outer layer defect

要約　目的：網膜外層欠損を伴う中心窩剝離に対する硝子体手術の2例を報告する。

症例：［症例1］　77歳，男性。5か月前から右視力低下。右視力（0.3），眼内レンズ眼，眼軸長24.11mm，光干渉断層計（OCT）で後部硝子体剝離，中心窩剝離，200μmの網膜外層欠損を認めた。硝子体手術では中心窩周囲3乳頭径大の内境界膜（ILM）剝離を行った。術後，中心窩剝離は徐々に減少し，術後1年で消失した。視力は（0.9）に改善した。［症例2］　81歳，女性。8か月前から右視力低下。右視力（0.05），眼軸長22.10mm，中程度白内障とOCTで後部硝子体剝離，中心窩剝離，900μmの網膜外層欠損を認めた。硝子体白内障同時手術でfovea-sparing ILM剝離とSF₆ガスタンポナーデを行い，術後伏臥位とした。黄斑円孔（MH）を生じたが，視力は（0.2）に改善した。術後1か月，再手術で円孔底色素上皮搔爬術とSF₆ガスタンポナーデを行い，術後伏臥位とした。再手術後MHは閉鎖し，術後6か月で視力は（0.6）に改善した。

考察：網膜外層欠損を伴う中心窩剝離例に対する硝子体手術は有効であった。中心窩外層欠損が大きい症例では，中心のILMを温存してもMHを生じる可能性がある。

Abstract　Purpose：To report two cases of vitrectomy for foveal retinal detachment with outer-retinal macular hole.

Case：Case one was a 77-year-old man with a chief complaint of visual loss in his right eye for 5 months. At his first visit, the best corrective visual acuity（BCVA）was 0.3 in the right eye. The lens status was intraocular lens. The axial length was 24.1 mm. Optical coherence tomography（OCT）showed a posterior vitreous detachment（PVD）and foveal retinal detachment with 200 μm outer retinal defect. Pars plana vitrectomy（PPV）with internal limiting membrane（ILM）peeling was performed. A year after surgery, the foveal retinal detachment resolved and the BCVA increased to 0.9. Case two was an 81-year-old woman with a chief complaint of visual loss in her right eye for 8 months. At her first visit, the BCVA was 0.05 in the right eye. The lens status was moderate degree cataract. The axial length was 22.1 mm. OCT showed PVD and a foveal retinal detachment with a 900 μm outer retinal defect. We performed phacoemulsification and posterior chamber intraocular lens implantation, PPV with fovea-sparing ILM peeling and SF6 gas tamponade. The patient needed to be placed in a prone position after the surgery. A month later, a macular hole（MH）developed. A second PPV with debridement of the retinal pigment epithelium and SF6 gas tamponade was performed. After the second surgery the MH was closed and the BCVA increased to 0.6.

Conclusion：PPV for macular detachment with outer layer defect is effective. However, in cases with a larger outer layer defect, MH may occur even if fovea-sparing ILM peeling is performed and the central ILM preserved.