二手法による硝子体手術

Bimanual technique in vitreous surgery

　眼内照明付きの硝子体鑷子と硝子体剪刀を用いた二手法による硝子体手術を行い，その手技と手術成績について検討した。症例は増殖性硝子体網膜症が4例4眼，増殖糖尿病網膜症が4例4眼であり，増殖性硝子体網膜症は4眼中3眼，増殖糖尿病網膜症は4眼全例が復位した。二手法による増殖膜処理は，硝子体鑷子で増殖膜を把持するため，癒着部の観察と剪刀による切開が容易であり，特に，硝子体基底部の増殖膜処理に有効であった。その際，両方の器具に照明があるために十分な視野を確保することができた。問題点としては，デスメ膜の雛襲による視認性の低下や増殖膜を牽引しすぎたための鋸状縁裂孔と毛様体扁平部上皮剥離などが認められた。

We evaluated the bimanual instrumentation for vitreous surgery produced by DORC, the Nether-lands. The system includes illuminated intraocular forceps and scissors. We performed vitreous sur-gery with this technique on 4 eyes each of prolifer-ative diabetic retinopathy and proliferative vitreo-retinopathy (PVR). The retina was reattached inall the eyes except one eye with PVR. With this instrumentation, the illuminated intraocular for-ceps held the proliferative membrane. Also, adhe-sions between the retina and proliferative mem-branes could be observed and dissected with ease. This technique was particularly helpful for dissect-ing membranes located in the vitreous base area. Better illumination by the two intraocular fiber-optics gave the surgeon added flexibility.