円板状黄斑変性症に伴う硝子体出血の超音波像と硝子体手術術前検査としての意義

Presurgical value of ultrasonography in vitreous hemorrhage secondary to disciform macular degeneration

　今回，われわれは硝子体出血を合併した円板状黄斑変性症に対し超音波検査を行い，本疾患の超音波所見ならびに硝子体手術適応について検討を加えた。

　超音波検査を行ったのは30例31眼で，そのうち硝子体手術を行ったのは14例14眼あった。硝子体病変の超音波所見について分類すると，単純な硝子体出血が3眼，硝子体網膜癒着を伴わない硝子体膜形成が21眼，硝子体網膜癒着を伴う硝子体膜形成が2眼，硝子体網膜癒着の不明な硝子体膜形成が5眼であった。また，超音波検査で後極部に隆起性病変を認めたものが22眼，認めなかったものが6眼あったが，残り3眼は広範な出血性網膜剥離を認めた。また，手術を行った14眼の視力予後は，隆起性病変の有無では差がみられず，最終視力は全例0.1以下であった。

　円板状黄斑変性症による硝子体出血の超音波所見は，硝子体網膜癒着を伴わない硝子体膜形成および後極部隆起性病変が特徴的であった。硝子体手術による視力予後は不良で，このような特徴的超音波所見により円板状黄斑変性症が疑われる場合，対側眼の状態により手術適応を決定すべきである。

We evaluated 31 eyes, 30 patients, of vitreous hemorrhage secondary to disciform macular degen-eration by ultrasonography during the foregoing 10 years. Ultrasonography showed simple vitreous hemorrhage without vitreous membrane in 3 and with vitreous membrane in 28. In the latter group, vitreoretinal adhesion was absent in 21, present in 2 and undetermined in 5. Elevated lesions in the posterior fundus was present in 22 and absent in 6. Extensive hemorrhagic retinal detachment was seen in another 3 eyes.

We performed pars plana vitrectomy in 14 eyes. The final visual acuity was less than 0.2 in all theoperated eyes. Spontaneous clearing of vitreous opacity resulted in 11 of 17 non-operated eyes. It took an average of 7.1 months before spontaneous resolution of hemorrhage. There was no difference in final visual acuity between operated and non -operated eyes.

Presence of vitreous membrane without vitreor-etinal adhesion was thus a frequent feature in the series. While absence of vitreoretinal adhesion would mean uncomplicated vitrectomy, the visual outcome is generally poor because of disciform macular lesions. We advocate vitrectomy only in patients with manifest age-related macular pathol-ogies in fellow eyes.