後部硝子体剥離に伴う裂孔原性網膜剥離の手術成績—一次的硝子体手術と強膜内陥術の比較

Outcome of primary vitrectomy for rhegmatogeneous retinal detachment associated with posterior vitreous detachment compared with scleral buckling procedure

　過去3年間に，後部硝子体剥離を伴う裂孔原性網膜剥離60眼に手術を行い，術後3か月以上の経過を観察した。黄斑円孔，巨大裂孔，外傷，増殖硝子体網膜症が関係する症例は除外した。うち35眼には初回手術として硝子体手術を行った。年齢は平均63.0±8.6歳である。他の25眼には強膜内陥術を行った。年齢は平均63.4±10.0歳である。初回復位率は，硝子体手術群が33眼（94％），強膜内陥術群が24眼（96％）であり，両群間に有意差はなかった（p＞0.99）。平均術後対数視力は，硝子体手術群が0.32±0.41，強膜内陥術群が0.23±0.32であり，両群間に有意差はなかった（p＝0.524）。全例を通じて重篤な合併症はなかった。以上の結果から，症例の状態に応じて，初回手術として硝子体手術を選択してよいと結論される。

Purpose: To evaluate the efficacy of primary pars plana vitectomy for rhegmatogenous retinal detachment associated with posterior vitreous detachment as compared with scleral buckling procedure. Cases: A total of 60 eyes of rhegmatogenous retinal detachment associated with posterior vitreous detach-ment were operated during the foregoing 3 years. Cases were excluded when associated with macular hole,giant retinal break, trauma, or proliferative vitreoretinopathy. They were followed up for 3 months or more af-ter surgery. Primary vitrectomy was performed on 35 eyes. The ages averaged 63.0 ± 8.6 years. The other 25 eyes received scleral buckling. Their ages averaged 63.4 10.0 years. Result : The retina became reattached after the initial surgery in 33 eyes (94%) following vitrectomy and in 24 eyes (96 %) following scleral buckling. There was no significant difference between the two groups (p＞0.99). Postoperatively, the logarithmic visual acuity averaged 0.32±0.41 following vitrectomy and 0.23±0.32 following scleral buckling. There was no sig-nificant difference between the two groups (p=0.524). Serious complications were absent throughout. Con-clusion: Primary vitrectomy was as effective as scleral buckling for rhegmatogenous retinal detachment as-sociated with posterior vitreous detachment.