裂孔原性網膜剝離に対するシリコーンオイルとヘビーシリコーンオイルタンポナーデの治療成績と合併症の比較検討

A comparison of outcomes and complications of silicone oil and heavy silicone oil tamponade for rhegmatogenous retinal detachment

要約　目的：裂孔原性網膜剝離（RRD）に対するシリコーンオイル（SO）とヘビーシリコーンオイル（HSO）の治療成績と合併症を比較した。

方法：RRDに対しSOまたはHSOを使用した連続症例を後ろ向きに調査した。主評価項目は合併症発生率と追加治療の割合，副次評価項目は合併症発生と他因子の関連，術後視力，解剖学的復位，術後眼圧とした。合併症ごとに，関連因子について検討した。

結果：SO群が58例60眼〔平均年齢 58.6歳，女性 13眼（21.7％）〕，HSO群は19例19眼〔平均年齢 59.0歳，女性 7眼（36.8％）〕。網膜復位率は，SO群で58眼（96.7％），HSO群で19眼（100.0％），オイル摘出以外の再手術はSO群9眼（15.0％），HSO群2眼（10.5％）で有意差がなかった。術後オイル前房脱出は，術後の水晶体囊の状態と関連していた。調整オッズ比は，水晶体囊なし群が120.09（95％信頼区間：3.28〜30206.65，p＝0.007）であった。

結論：SO群とHSO群で術後の合併症，網膜復位率，視力，術後眼圧に差はない。術後のオイル前房脱出はオイルの種類ではなく，水晶体囊の状態と関連していた。

Abstract　Purpose：To compare the treatment outcomes and complications of retinal reattachment surgery using silicone oil（SO）and heavy silicone oil（HSO）for rhegmatogenous retinal detachment（RRD）.

Methods：A retrospective study was conducted on consecutive cases of RRD undergoing 25-gauge pars plana vitrectomy（PPV）with either HSO or SO at Kagoshima University Hospital between June 2017 and December 2022. The primary outcomes measures were the incidence of complications and the rate of additional treatments, whereas the secondary outcomes included the association of complications with other factors, postoperative visual acuity（at 1, 3, and 6 months, as well as at 1 year）, anatomical reattachment, and postoperative intraocular pressure（IOP）. Logistic regression analysis was performed to investigate the association between identified factors and the occurrence of complications.

Results：The HSO group comprised 19 cases（19 eyes；mean age, 59.0±17.0 years；female, 7 eyes（36.8％））, whereas the SO group consisted of 58 cases（60 eyes；mean age, 58.6±14.6 years；female, 13 eyes（21.7％））. More inferior retinal tears were observed in the HSO group（P＝0.028）. The retinal reattachment rate was 96.7％（58 eyes）in the SO group and 100％（19 eyes）in the HSO group（P＞0.999）. The rates of additional surgeries excluding oil removal were 15.0％（9 eyes）in the SO group and 10.5％（2 eyes）in the HSO group, with no significant difference（P≥0.627）. No significant difference in IOP was observed. Postoperative oil anterior chamber prolapse was associated with the condition of lens postoperatively. The adjusted odds ratio was 120.09（95％ CI：3.28-30206.65, P＝0.007）for the group without a crystalline lens.

Conclusion：No differences were observed between the SO and HSO groups in regard to postoperative complications, anatomical reattachment rate, visual acuity changes, or postoperative IOP. Postoperative oil anterior chamber prolapse was related to the condition of lens rather than the type of oil used.