白内障・硝子体手術同時施行例における術後屈折誤差の検討

Postoperative refractive error in simultaneous cataract and vitreous surgery

要約　目的：白内障・硝子体同時手術における屈折誤差を調査する。さまざまな眼底疾患を含めた調査を行い，眼底疾患別の屈折誤差の傾向を検討する。

対象と方法：2020年4月〜2021年3月の間に昭和大学病院附属東病院で行った，白内障・硝子体手術同時施行例のなかで，術後半年の矯正視力0.5以上ある症例を対象とする。症例の内訳は裂孔原性網膜剝離（RRD）55眼（黄斑非剝離31眼，黄斑剝離24眼），網膜前膜（ERM）47眼，硝子体出血（VH）23眼，黄斑円孔（MH）14眼の計139眼であった。術後1か月後の屈折誤差をレトロスペクティブに検討した。

結果：±0.5D未満の屈折誤差となった症例の割合は全体では54.6％，個別の疾患ではRRD50.9％，ERM68.0％，VH52.1％，MH35.7％であった。平均屈折誤差は全体では−0.48±0.68D，個別の疾患ではERM−0.30±0.60D，RRD−0.61±0.77D，VH−0.46±0.61D，MH−0.56±0.64Dであった。各群の精度，平均屈折誤差に有意差は認めなかった。RRDやMHといった液空気置換をする疾患としない疾患に分けた場合，液空気置換ありが82眼，なしが53眼であった。±0.5D未満の屈折誤差となった症例の割合は，ガスタンポナーデあり群が48.8％，なし群が64.9％であった。平均屈折誤差は，液空気置換あり群が−0.59±0.72D，なし群が−0.32±0.60Dであり，平均屈折誤差に関しては有意差を認めた。

結論：±0.5D未満の屈折誤差，平均屈折誤差で検討した場合，疾患ごとの比較で有意差を認めなかった。液空気置換の有無で検討した場合，液空気置換をした症例のほうがしなかった症例に比べて，有意に近視化した。

Abstract　Objective：To investigate refractive error in simultaneous cataract and vitreous surgery and to include various ocular fundus diseases and examine the trend of refractive error by fundus diseases.

Subjects and Methods：Patients who underwent simultaneous cataract and vitreous surgery at Showa University East Hospital from April 2020 to March 2021 and had a corrected visual acuity of 0.5 or more at six months postoperatively were included in this study. The total number of eyes 139, including 55 with rhegmatogenous retinal detachment（RRD）（31 with macular non-detachment and 24 with macular detachment）, 47 with epiretinal membrane（ERM）, 23 with vitreous hemorrhage（VH）, and 14 with macular hole（MH）. Refractive errors at 1 month postoperatively were retrospectively examined.

Results：The percentage of cases with a refractive error of less than ±0.5D was 54.6％ overall, 50.9％ for RRD, 68.0％ for ERM, 52.1％ for VH, and 35.7％ for MH. The mean refractive error was −0.48±0.68D overall, −0.30±0.60 for ERM, −0.61±0.77D for RRD, −0.46±0.61D for VH, and −0.56±0.64D for MH. There were no significant differences in accuracy or mean refractive error between the groups. When divided into diseases with and without fluid air exchange, such as RRD and MH, there were 82 eyes with fluid air exchange and 53 eyes without. The percentage of patients with a refractive error of less than ±0.5D was 48.8％ in the group with fluid air exchange and 64.9％ in the group without fluid air exchange. The mean refractive error was −0.59±0.72D for the group with fluid air exchange and −0.32±0.60 D for the group without fluid air exchange. There was a significant difference in the mean refractive error.

Conclusions：When examining refractive error of less than ±0.5D and mean refractive error, no significant differences were found in the disease-by-disease comparisons. When examined with and without fluid air exchange, cases with fluid air exchange were significantly more myopic than those without.