裂孔原性網膜剥離の手術成績

Surgical outcomes in rhegmatogenous retinal detachment

　最近5年間に当科で行った裂孔原性網膜剥離1,025眼の手術成績を検討した。初回手術で強膜内陥術を85％，硝子体手術を8％，気体注入術を7％に行った。初回手術未復位例111眼に対して，硝子体手術を42％，強膜内陥術を39％，気体注入術を19％に行った。何らかの硝子体手術を行った症例は121眼（12％）であった。総手術回数は1,171回，1眼当たりの平均は1.14回であった。退院時の復位率は97％であった。術後に脈絡膜剥離が8％，黄斑皺襞が4％，増殖性硝子体網膜症が3％に発生した。裂孔原性網膜剥離の基本術式として，通常例では強膜内陥術で良い成績を得たが，難治例の網膜復位率の向上と手術回数の減少には硝子体手術が貢献していた。

We reviewed the result of surgery on 1,025 eyes of rhegmatogenous retinal detachment during the foregoing 5 years. The initial surgery comprised scleral buckling in 85%, vitreous surgery in 8% and pneumatic retinopexy in 7%. The retina became reattached in 907 eyes. Another 111 eyes were treated by additional surgery including vitreous surgery in 42 %, scleral buckling in 39% and pneumatic retinopexy in 19%. A total of 121 vitreous surgeries were thus performed. At the time of discharge, the retina was anatomically reattached in 97% of the eyes. Postoperative complications included choroidal detachment in 8%, macular pucker in 4%, and proliferative vitreoretinopathy in 3%. The findings show that scleral buckling is currently the standard procedure for usual cases of rhegmatogenous retinal detachment and that better surgical outcome can be attained by vitreous surgery for complicated cases.