硝子体手術後に黄斑円孔が生じた網膜静脈分枝閉塞症

Macular hole formation following vitrectomy for complications of branch retinal occlusion

　54歳男性が1か月前からの左眼変視症と視力低下で受診した。左眼の矯正視力は0.3で，眼底に線維血管増殖膜と牽引性黄斑剥離があり，蛍光眼底造影で陳旧性の網膜静脈分枝閉塞症と診断した。硝子体手術で，増殖膜剥離，ガスタンポナーデ、眼内レーザー凝固を行った。手術1週後に全層黄斑円孔が発見された。黄斑円孔手術により円孔は閉鎖し，最終視力0.7が得られた。黄斑円孔の原因として，牽引性剥離で萎縮し薄くなった黄斑部網膜がガスタンポナーデで伸展され，中心窩で断裂した可能性が考えられた。

A 54-year-old male presented with metamorphopsia and decreased visual acuity in his left eye since one month before. The corrected visial acuity was 0.3 left. The left fundus showed fibrovascular proliferation with tractional macular detachment. Fluorescein angiography led to the diagnosis of chronic branch retinal vein occlusion. The affected eye underwent vitrectomy with membrane peeling, gas tamponade and endolaser photocoagulation. Full-thickness macular hole was detected one week after surgery. Additional surgery led to closure of macular hole resulting in the final visual acuity of 0.7. The postoperative macular hole was interpreted as due to stretch effect of gas tamponade to the atrophic and thinned fovea.