Nd-YAGレーザーによる網膜裂孔弁の切断

Retinotomy with Nd-YAG laser

　牽引性網膜裂孔への硝子体牽引を切断する目的で，網膜裂孔弁状部にQスイッチ型　Nd—YAGレーザーを照射して網膜裂孔弁を切断し，網膜剥離13眼および網膜裂孔3眼の治療を試みた。網膜裂孔弁における硝子体牽引は，16眼中14眼で切断できた。切断が可能であった網膜剥離12眼中，9眼にYAGレーザーによる網膜裂孔弁の切断後，gas tamponadeを施行した。一部の症例には強膜内陥術を行った。全例で網膜は復位し，重篤な合併症はなかった。YAGレーザーによる網膜裂孔弁の切断は，弁状網膜裂孔弁の硝子体牽引を解除するのに有効であると考えられた。

We applied Q switched Nd-YAG laser to release vitreous traction to retinal breaks by severing the retinal flap. We treated 16 eyes: 13 eyes with primary rhegmatogenous retinal detachment and 3 eyes with tractional retinal breaks without retinal detachment. We aimed the Nd-YAG laser beam at the retinal flap overlying the breaks through Gold-mann three-mirror lens under maximum mydriasis. The number of laser bursts averaged 129 before the flap was completely severed. The laser treatment resulted in release of vitreous traction to the breaks in 14 eyes, 88 %. We performed pneumatic retinopexy in 9 eyes after successful release of vitreous traction by laser. Additional scleral buck-ling procedure was necessary in 4 of these eyes. Reattachment of the retina resulted in all the 9 eyes. Transient bleeding from the site of retinotomy occurred in 4 eyes. A new tear devel-oped later in one eye. The procedure promises to be of value. It may reduce the risk of redetachment by permanent release of vitreous traction to the retina.