硝子体手術で復位した近視性黄斑円孔網膜剥離の円孔形態

Tomographic features of macular hole in high myopic eyes following resolution of retinal detachment by vitreous surgery

　硝子体手術で円孔縁に光凝固せずに網膜が復位した，近視性黄斑円孔網膜剥離10眼の黄斑部を光干渉断層計（OCT）で観察し，円孔形態と視力転帰を検討した。硝子体手術では5眼で黄斑前の硝子体皮質を除去し，5眼でさらに円孔周囲の内境界膜を剥離した。硝子体皮質を除去した5眼中3眼で円孔が閉鎖し，中心窩の陥凹が復活した。2眼は円孔が開口したまま網膜が復位していた。内境界膜を剥離した5眼はすべて，円孔が開口したまま網膜が復位していた。円孔閉鎖群と非閉鎖群では，視力転帰に相関はなかった。黄斑円孔網膜剥離では，硝子体手術で網膜が復位しても多くは円孔閉鎖しないことが，術後の再発率が高い一因と考えた。

We observed the cross-sectional images of macular holes in 10 severely myopic eyes with retinal detachmentafter vitrectomy surgery using optical coherence tomography (OCT). All 10 eyes obtained successful retinal reattachmentwith vitreous surgery, in which premacular vitreous cortex was removed in 5 eyes and internal limiting membrane wasadditionally peeled in the remaining 5 eyes. In the 5 eyes with vitreous cortex removal, macular hole was closed withrestored foveal depression in 3 eyes but remained open in 2 eyes. Macular hole remained open in all 5 eyes with removalof vitreous cortex and internal limiting membrane. There was no statistical difference in visual outcomes between 3 eyeswith closed macular hole and 7 eyes with patent macular hole. Our data show a high incidence of patent macular hole inseverely myopic eyes that obtained retinal reattachment by vitreous surgery. This may explain frequent recurrence ofretinal detachment.