黄斑裂孔網膜剥離に対する硝子体手術

Vitrectomy for retinal detachment with macular hole

　黄斑裂孔網膜剥離12例12眼に硝子体手術を行った。全例女性で，56〜84歳，観察期間3〜46か月。高度近視が11眼，増殖膜を伴う正視が1眼。初回術式は，ガスタンポナーデ4眼，硝子体手術7眼，裂孔不明の1眼に輪状締結を行った。硝子体手術とガスタンポナーデで7眼中6眼が復位，1眼はシリコンタンポナーデで復位した。シリコンタンポナーデを行った5眼中2眼が復位した。残りの1眼は黄斑バックルで復位し，1眼は後極に剥離が残存，1眼は術中脈絡膜出血のため復位しなかった。復位した10眼中8眼に光凝固を追加した。深い後ぶどう腫を持つ2眼ではシリコンタンポナーデ後に後極に剥離が残存し，黄斑バックルの適応であったと考えられた。

We reviewed the outcome of vitrectomy in 12 eyes of retinal detachment with macular hole. All cases were females. The ages ranged from 56 to 84 years. The follow-up period ranged from 3 to 46 months. Eleven eyes were high myopia and one eye was emmetropia with epimacular membrane. As the first surgical procedure, pneumatic retinopexy was performed in 4 eyes, vitrectomy in 7 eyes and scleral encircling in one eye. Out of 7 eyes treated by vitrectomy and gas tamponade, 6 resulted in reattachment and the other could be reattached by additional silicone-oil tamponade. In other 5 eyes, reattachment was induced by vitrectomy and sili-cone oil tamponade in 2 eyes and by macular buckling in 1. Retinal detachment in the posterior staphylomatous area remained in 1. One eye failed to reattach due to intraoperative choroidal hemor-rhage. Additional laser photocoagulation was applied in 8 of 10 eyes after retinal reattachment. Persistence of retinal detachment in the posterior staphylomatous fundus seemed to suggest that macular buckling is indicated for such cases.