アトピー性皮膚炎に伴う網膜剥離の手術

Surgery for rhegmatogenous retinal detachment associated with atopic dermatitis

　最近6年間に当科で手術を行ったアトピー性皮膚炎に伴う網膜剥離43眼について調査した。網膜剥離の状態は2型あった。1つは弁状裂孔や萎縮性円孔による赤道部型の網膜剥離20眼で，強膜内陥術で網膜剥離は復位した。他は鋸状縁断裂や毛様体上皮裂孔によるアトピー性皮膚炎に特徴的な眼底最周辺部型の網膜剥離23眼で，強膜内陥術を83％，硝子体手術を13％に行い，網膜剥離は復位したが，5眼は新しく毛様体上皮裂孔が発生して再剥離した。最終的には網膜剥離は全例復位した。アトピー性皮膚炎に伴う網膜剥離の基本術式は輪状締結術だが，症例により硝子体手術が必要である。本疾患も適当な手術で充分治癒せしめることができ，治療成績は良好であった。

We reviewed a series of 43 eyes of rhegmatogenous retinal detachment associated with atopic dermatitis during the foregoing 6 years. There were two types of retinal detachment: equator type 20 eyes and peripheral type 23 eyes. The equator type with flap tears or atrophic holes in the equator was success-fully treated by scleral buckling. The peripheral type with breaks in the ora serrata or the ciliary epithelium was treated by scleral buckling in 19 eyes and by vitrectomy in 3 eyes. Retinal detachment recurred in 5 of these eyes due to formation of new breaks in the ciliary epithelium. Final reattachment was obtained in all the cases. We advocate scleral buckling procedure as the first choice for rhegmatogenous retinal detachment associated with atopic dermatitis and vitrectomy in selected cases.