当院における外傷性黄斑円孔の治療成績

Treatment outcomes of traumatic macular hole

要約　目的：眼球打撲傷による外傷性黄斑円孔の治療成績を報告する。

対象と方法：対象は，2013年4月〜2023年3月に昭和大学病院附属東病院（以下，当院）を眼球打撲傷のため受診し，外傷性黄斑円孔と診断された6例6眼である。性別，年齢，受傷機転，黄斑部合併症の有無，後部硝子体剝離の有無，光干渉断層計（OCT）所見，治療方法，視力について，診療録よりレトロスペクティブに抽出した。なお，外傷性黄斑円孔の治療方針は，経過観察ののちに，OCT所見上，円孔径の拡大やfluid cuffの立ち上がりを認め，円孔の自然閉鎖が期待されない症例に対して硝子体手術を施行した。

結果：6例全例が男性であった。内訳は，10歳台が4例，20歳台が1例，30歳台が1例であった。受傷機転は全例がボールの直撃であった。自然閉鎖を認めた症例は4例で，受傷より1か月以内で閉鎖した症例が3例，受傷後16週で閉鎖した症例が1例であった。4例中1例にのみfluid cuffを認めたが，架橋構造がみられたため経過観察とし，その後自然閉鎖した。硝子体手術例は2例であり，術前OCT所見にてfluid cuffを認めたが，最終的な黄斑円孔閉鎖率は100％であった。最終logMAR視力の平均は，自然閉鎖群で0.011±0.113，手術群で−0.08±0であった。

結論：外傷性黄斑円孔は，球技を行う若年者で発症する傾向にあった。OCT所見に着目した治療方針で，良好な視力予後が得られた。

Abstract　Purpose：This study aims to present the treatment outcomes in case of traumatic macular holes caused by ocular trauma.

Methods：The study included six patients with traumatic macular holes encountered at Showa University East Hospital between April 2013 and March 2023. Pertinent demographic data including sex, age, injury profile, the presence of macular complications, the presence of posterior vitreous detachment, optical coherence tomography（OCT）findings, treatment methods, and visual acuity were retrospectively obtained from clinical archives. The therapeutic approach for traumatic macular holes entailed vitrectomy for patients whose OCT findings showed a large macular hole or a fluid cuff, and for whom spontaneous closure was considered unlikely.

Results：All of the subjects were male. Four were teenagers, one was in his 20s, and one was in his 30s. The inciting event for all cases was a direct ocular impact from a ball. Spontaneous closure occurred in four cases；three cases within one month and one case sixteen weeks after injury. One of these four patients had a fluid cuff, but since cross-linked structures were observed, the patient was followed and spontaneous closure was observed thereafter. The remaining two patients underwent vitrectomy, resulting in a final macular hole closure rate of 100％, despite the preoperative presence of perifoveal fluid accumulation on OCT findings. The mean final visual acuity, as measured using the logarithm of the minimum angle of resolution（logMAR）chart, was 0.011±0.113 and −0.08±0 in the patients demonstrating spontaneous closure and in those who underwent surgical intervention, respectively.

Conclusion：Traumatic macular holes often occur in young players of ball sports. A treatment strategy focused on OCT findings resulted in better visual outcomes.