未熟児網膜症に対する光凝固治療後の視機能

Visual functions after photocoagulation for retinopathy of prematurity

　光凝固治療後の瘢痕期未熟児網膜症の視力，眼位，両眼視機能について長期経過を観察した。矯正視力は光凝固により瘢痕期1度で治癒した症例（瘢痕期1度PHC，以下同）では97.4％，2度弱度PHCでは100％が0.6以上であった。また，両眼ともが瘢痕期1度PHCないし2度弱度PHCであれば，眼位，両眼視は良好であった。一方，瘢痕期2度中等度PHC，強度PHCの症例では視力は一般的に不良であり，また1眼でも瘢痕期2度中等度PHCないし強度PHCであれば，眼位，両眼視機能は不良であった。全周光凝固例の視機能は，原則的には，瘢痕期の程度に左右された。

　視機能予後から判断すれば，未熟児網膜症重症活動期病変に対しては，治療のtimingを逸することなく，両眼ともが瘢痕期1度PHCないし悪くても2度弱度PHCでおさまるように治療すべきである。

We evaluated 67 patients, 128 eyes, with cicatricial retinopathy of prematurity to evaluate the long-term results after photocoagulation (PHC). The age of the patients ranged from 8 to 21 years, average 13.8 years. The stage of the fundus was graded according to the standard criteria in Japan: grade a PHC means only artificial PHC scar; mild grade 2 PHC means dragged disc, nor-mal macula with peripheral PHC scar; moderate to severe grade 2 PHC means dragged disc, distor-tion and macular ectopia with peripheral PHC scar. Cases with more advanced cicatrization with trac-tion retinal detachment etc were excluded from the study.

The visual acuity was good in eyes with grade 1PHC and mild grade 2 PHC, as 105 of 107 eyes, 98. 1%^*, had visual acuity of 0.6 or better. It was poor in eyes with moderate and severe grade 2 PHC, as 5 of 21 eyes, 23.8%^*, had visual acuity of 0.6 or better. Patients with grade 1 PHC and mild grade 2 PHC in both eyes had good ocular alignment and binocular vision, with phoria in 46 out of 52 patients, 88.5%^*, and good stereopsis of 60° or better in 33 of 52 patients, 63.5%^*. Patients with moderate or severe grade 2 PHC had poor ocular alignment and binocular vision, with phoria in 4 of 14 patients, 28.6%*, and good stereopsis in 1 of the 4,7.1%^*. Above differences were significant (^*p＜ 0.01). Visual functions in eyes with full-circumfer-ential PHC was dependent on the cicatricial stage of the fundus.