偽黄斑円孔手術における内境界膜剥離

Peeling of internal limiting membrane for macular pseudoholes

　偽黄斑円孔手術における内境界膜剥離の影響を検討した。同一術者が行った偽黄斑円孔手術の99例105眼を対象とした。男性30例33眼，女性69例72眼，年齢は39〜85歳，平均66歳であった。内境界膜剥離群75眼と非剥離群30眼に分け，偽黄斑円孔消失率，術後の黄斑円孔発生率および視力成績を比較した。偽黄斑円孔消失率は内境界膜剥離群が87％，非剥離群が20％（p＜0.0001），黄斑円孔発生率は内境界膜剥離群が11％，非剥離群が7％（p＝0.53）であった。術後視力は2群とも有意に改善した。術後平均視力は内境界膜剥離群が0.92，非剥離群が0.84（p＝0.14）であった。偽黄斑円孔手術における内境界膜剥離は偽黄斑円孔所見を改善するが，視力成績には有効ではなく，黄斑円孔の発生率を高くする。内境界膜剥離は避けるべきかもしれない。

We evaluated the influence of peeling of internal limiting membrane (ILM) in macular pseudohole surgery in 105 eyes of 99 cases. The cases comprised 33 eyes of 30 males and 72 eyes of 69 females. The ages ranged from 39 to 85 years, average 66 years. Surgery was performed by one surgeon throughout. The ILM was peeled in 75 eyes. The other 30 eyes received posterior vitrectomy only. Postoperatively, macular pseudohole disappeared in 87% of eyes receiving ILM peeling and in 20% of eyes receiving vitrectomy only. The difference was significant (p＜0.0001). Postoperatively, macular hole developed in 11% of eyes receiving ILM peeling and in 7% of eyes receiving vitrectomy only. The difference was not significant (p=0.53). The visual acuity improved significantly in both groups after surgery, averaging 0.92 in eyes receiving ILM peel-ing and 0.84 receiving vitrectomy only (p=0.14). The findings show that ILM peeling induce a higher rate of disappearance of macular pseudohole but that it has no effect on the visual outcome and may increase the rate of macular hole after surgery. ILM peeling may not be advocated for macular pseudoholes.