黄斑円孔手術における非閉鎖例と再発例への処置

Treatment for non-closure or recurrence after macular hole surgery

　過去34か月間に特発性黄斑円孔161眼（157例）に硝子体手術を行った。円孔の閉鎖・消失は，初回手術で111眼（69％），追加処置により最終的に147眼（91％）で得られた。閉鎖率は2回以内の液ガス置換で85％（137／161眼）に向上し，再手術での閉鎖（12／13眼）と自然閉鎖（1眼）を加えると93％（150／161眼）となった。再発が8眼（5％）にあり，円孔周囲の網膜前膜除去を含む再手術で4眼が閉鎖した。黄斑円孔は陳旧例でなければ，初回手術で非閉鎖でも，ガス追加と再手術で高率に閉鎖できる。

Vitreous surgery was performed on 161 eyes of 157 cases of idiopathic macular hole during the foregoing 34 months. Closure of macular hole was achieved in 111 eyes (69%) after initial surgery. The rate of closure improved from 69% to 85% (137/161) after fluid/gas exchange was performed once or twice. Ultimate closure was obtained in 147 eyes (91%) as an additional vitrectomy induced hole closure in 12 of 13 eyes and as one eye showed spontaneous late closure. Recurrence of the hole occurred in 8 eyes (5%) , of which 4 eyes were successfully treated by additional vitrectomy with removal of the epiretinal membrane around the hole. The findings show that, even after apparent failure after initial surgery, macular holes can be closed at a high incidence by additional treatments except longstanding ones.