黄斑部硝子体手術の合併症

Complications of vitreous surgery for macular lesions

　過去20か月間に行った黄斑疾患に対する硝子体手術92眼の合併症を検索した。特発性黄斑円孔65眼での合併症は，術中の周辺部網膜裂孔1脹，術後の裂孔原性網膜剥離3眼，術後の脈絡膜出血と硝子体出血各1眼，黄斑円孔の再発1眼，周辺視野欠損3眼であった。嚢胞様黄斑浮腫5眼では，術後に裂孔原性網膜剥離が2眼に生じた。黄斑下血腫7眼では，網膜色素上皮欠損が3眼，裂孔原性網膜剥離と網膜静脈分枝閉塞症が各1眼に生じた。黄斑前膜13眼と外傷性黄斑円孔2眼では硝子体手術による合併症はなかった。黄斑疾患に対する硝子体手術では，医原性網膜裂孔を作らないような配慮が必要であり，術前と術中に硝子体基底部を十分に検索することが望まれる。黄斑円孔への手術後の視野欠損は，術中に後部硝子体剥離を作成することとは無関係であった。

We reviewed the complications of vitreous surgery for macular lesions in 92 eyes during a 20-month period. In 65 eyes of idiopathic macular hole, peripheral retinal break was detected intraoperatively in 1 eye, postoperative rhegmatogenous retinal detachment in 3 eyes, recurrence of macular hole in 1 eye and peripheral visual field constriction in 3 eyes. In 5 eyes of cystoid macular edema, rhegmatogenous retinal detachment developed postoperatively in 2 eyes. In 7 eyes of submacular hematoma, tear of retinal pigment epithelium developed in 3 eyes and rhegmatogenous retinal detachment and branch retinal vein occlusion in one eye each. No complications developed in 13 eyes of epiretinal membrane and in 2 eyes of traumatic macular hole. The findings show the necessity to avoid creation of retinal tear by careful inspection of the vitreous base before and during surgery. The visual field defect after surgery for macular hole was not related to intraoperative posterior vitreous detachment.