Erbium-YAGレーザーによる硝子体手術

Erbium-YAG laser in vitreous surgery

（V−13）　Erbium-YAGレーザーによる硝子体手術機器（WaveLight社製）の実用性と安全性を知るために，実験的に作製した増殖性網膜硝子体症および硝子体出血眼にて硝子体切除を施行し，その実用性を検討した。Erbium-YAGレーザーの波長は2.94μmで，レーザーの出力は5mJから40mJ，周波数は20Hzから70Hzの頻度を選択可能であった。正常硝子体線維は10mJ,20Hzの条件で切除・吸引でき，血液凝固塊および増殖組織は出力あるいは周波数を上げることでさらに効率的な切除が可能だった。Erbium-YAGレーザー硝子体切除装置は，切れ味の劣化はみられず十分に実用的であったが，今後その安全性についてさらに検討する必要があると考えられた。

Purpose : To evaluate erbium-YAG laser for incision and ablation of experimental proliferative vitreoretinopathy.

Method : Vitreal strands and traction retinal detachment were induced in 6 rabbit eyes and vitreous hemorrhage in 10 enucleated pig eyes. Using an erbium-YAG vitrectomy system (Adagio, WaveLight Co) . laser of 2.94 gm in wavelength was delivered through a flexible fiber of 320 gm in diameter and an endoprobe with 900 gm in diameter. The laser power output ranged from 5 to 40 mJ and the frequency from 20 to 70 Hz.

Results : Core vitrectomy could be performed with the setting of 10 mJ and 20 Hz. Vitreal proliferation and hemorrhage could be ablased much easier with the setting of 20 mJ and 20Hz. There were no complications including unintended retinotomy or reduction in ablation ability.

Conclusion : Erbium-YAG laser promises to be a useful adjunct in vitreous surgery after safety factors will have been cleared.