黄斑円孔手術の成績

Surgical outcome of idiopathic macular holes

（展示207）　黄斑円孔に対して硝子体手術を施行した38例42眼について手術成績を検討した。症例はGass分類でstage 2が7眼，stage 3が27眼，stage 4が8眼であった。術式は後部硝子体剥離作成後，後部硝子体膜および網膜上膜を除去し，エアーまたはガスタンポナーデを行った。再手術例など難治症例には黄斑円孔底の色素上皮の擦過除去を併用した。初回手術で42眼中30眼（71％）に黄斑円孔の閉鎖消失が得られ，再手術で6眼中4眼に閉鎖消失が得られ，最終成功率は81％であった。初回手術でガスタンポナーデを用いた群は20眼中18眼（90％）に閉鎖消失が得られ，エアータンポナーデに比べ有意に良好な成績であった。さらに術後合併症では，核白内障の進行を考慮すべきであった。

We reviewed the outcome of vitreous surgery for idiopathic macular hole in 42 eyes of 38 patients. Before surgery, the macular hole was in stage 2 in 7 eyes, stage 3 in 27 eyes and stage 4 in 8 eyes. During pars plana vitrectomy, the cortical vitreous or epiretinal membrane adherent to the retinal surface was removed followed by air or gas tamponade. Scraping of retinal pigment epithelium through the hole was added in difficult cases. Closure and disappearance of macular hole was obtained in 30 eyes (71%) after the first operation and in 4 out of 6 eyes after the second operation, resulting in overall success rate of 81%, Closure and disappearance of macular hole was obtained in 18 out of 20 eyes (90%), when gas tamponade was used during the first operation. This result was significantly better than eyes treated by air tamponade. Progression of nuclear cataract was a major postsurgical complication.