Qスイッチアレキサンドライトレーザーによる黄斑円孔に対し硝子体手術を施行した1例

Vitrectomy for traumatic macular hole secondary to Q-switched alexandrite laser

要約　目的：アレキサンドライトレーザーによる外傷性黄斑円孔に対して硝子体手術を施行し，視機能改善を認めた症例を報告する。

症例：40歳，女性。職業は美容クリニックの看護師。アレキサンドライトレーザーを清掃中に右眼に誤照射し，直後より霧視を自覚した。前医を受診し，硝子体出血を認めたためプレドニゾロン内服が開始となり，精査加療目的に受傷14日目に当科を受診した。初診時の右眼の視力は（0.3）で，光干渉断層計では横径545μm，縦径198μmの黄斑円孔と黄斑円孔耳側に白斑を認めた。自然閉鎖を期待したが，視力と黄斑円孔のサイズに改善を認めなかったため，受傷42日目に水晶体再建術併用硝子体手術を行った。内境界膜（ILM）を剝離し，ILM翻転法により黄斑円孔を被覆し，硝子体腔を20％SF₆ガスで置換した。

結果：黄斑円孔は閉鎖し，術後12か月間で視力は（0.8）まで改善した。歪視はMチャート上，垂直方向は0.5から0.2，水平方向は0.8から0.5まで改善した。

結論：Qスイッチアレキサンドライトレーザーによる外傷性黄斑円孔では，水晶体再建術併用硝子体手術とILM翻転法により視機能が回復する可能性が考えられた。

Abstract　Purpose：To report a case of vitrectomy for a traumatic macular hole caused by alexandrite laser and improvement of visual function.

Case：A 40-year-old nurse accidentally irradiated her right eye while cleaning alexandrite laser equipment. Immediately afterward, she became aware of blurred vision. She visited her previous doctor, who found a vitreous hemorrhage and initiated treatment with prednisolone. She visited our clinic on the 14th day after the injury for close examination and treatment. At the initial visit, the corrected visual acuity of the right eye was 0.3, and a macular hole and leukocoria were observed just beside the macular hole. The horizontal and vertical diameters of the macular hole were 545 μm and 198 μm, respectively. We expected spontaneous closure, but since there was no improvement in the visual acuity and macular hole size, a phacovitrectomy was performed on day 42 of the injury. The internal limiting membrane was peeled, the macular hole was covered by the internal limiting membrane, and the vitreous was replaced with 20％ SF₆ gas.

Results：The macular hole was closed, and the corrected visual acuity improved to 0.8 at 12 months postoperatively. Metamorphopsia improved from 0.5 to 0.2 vertically and from 0.8 to 0.5 horizontally on the M-chart.

Conclusion：Following Q-switched alexandrite laser-induced trauma to the macular hole, phacovitrectomy using an internal limiting membrane may restore help visual function.