硝子体手術中に網膜動脈に循環障害を生じた3症例

Three cases of circulatory disturbance in retinal artery during vitrectomy

（26B2-11）　過去4年間に行った硝子体手術936例のうち，3例に一過性の網膜動脈の循環障害が生じた。手術の原因疾患は，それぞれ裂孔原性網膜剥離，黄斑円孔，網膜剥離手術後の網膜上膜であった。全例に共通して，動脈循環障害は硝子体手術中の液空気置換術の開始早期に発症した。網膜に軟性白斑が生じ，1例では網膜色素上皮の萎縮が残った。機序は不明であるが，術中と術後の経過観察から，空気置換が網膜動脈の攣縮の誘因になった可能性が大きい。稀ではあるが，硝子体手術の合併症として注意されるべきである。

Out of a consecutive series of 936 cases of vitreous surgery during the foregoing 4 years, 3 cases developed temporary circulatory disturbance of retinal arterial branches during surgery. These 3 eyes underwent vitreous surgery for, respectively, rhegmatogenous detachment, macular hole and epiretinal membrane following retinal detachment surgery. Circulatory disturbance developed, in all the 3 cases, just before fluid-air exchange was completed. Soft exudates along the occluded retinal arterial branch were another common clinical feature. One case developed persistent atrophy of retinal pigment epithelium in the affected sector. Intra- and postoperative findings suggested that fluid-air exchange served as trigger for constriction of retinal arteries. This complication, although rare, merits due attention during vitreous surgery.