黄斑下血腫除去術に伴い黄斑円孔を生じた2例

Two cases of macular hole formation following excision of submacular hemorrhage secondary to ruptured arterial macroaneurysm

　網膜細動脈瘤破裂による新鮮な黄斑下血腫2眼に対して血腫除去術を行い，その術中に黄斑円孔が生じた。1眼では，網膜下にある血液を除去する目的で網膜下腔に灌流液を注入した際に中心窩を通じて灌流液が噴出し，黄斑円孔になった。意図的な内境界膜切除は行わなかった。術後28か月の時点でも円孔は閉鎖されなかった。他の1眼では，後部硝子体剥離後に内境界膜を剥離し，内境界膜下血腫の吸引中に黄斑円孔が生じた。18週後に黄斑円孔は自然閉鎖した。内境界膜除去が黄斑円孔の閉鎖に寄与したと推定される。

Macular hole developed in 2 eyes during surgery for submacular hematoma secondary to ruptured arterial macroaneurysm. One eye was receiving irrigation of subretinal space to remove residual hemorrhage. The irrigating solution spurted anteriorly through the fovea resulting in macular hole. No additional removal of internal limiting mem-brane (ILM) was performed. The macular hole persisted after 28 months of surgery. The other was receiving detach-ment of posterior vitreous membrane followed by excision of ILM. Macular hole developed during aspiration of he-matoma posterior to ILM. The macular hole spontaneously closed 4.5 months later. It appears that IOL removal was a contributing factor in the closure of macular hole.