切迫黄斑円孔への光凝固の効果

Laser treatment for impending macular hole

　切迫黄斑円孔22例23眼にレーザー光凝固を実施し，高率に円孔化を阻止することができた。黄斑嚢胞（stage 1B）の9眼では，視力改善が4眼，不変が5眼で，全例で0.4以上を維持できた。黄斑嚢胞に裂隙のある14眼（stage 2）では，12眼で不変，2眼で改善した。14眼中8眼では，最終的に0.2以上を維持した。新鮮黄斑円孔（stage3）の11眼では1眼以外，効果がなかった。

　光凝固は590または610nmの波長で，嚢胞から200〜300μm離して，豆まき状または輪状に7〜10数発行った。術後1〜2週間で，フジツボ状に隆起した黄斑嚢胞は平坦化し，視力の改善が始まり，1か月後にはほぼ固定した。

　以上の成績は，硝子体手術のそれに匹敵し，光凝固が切迫円孔の治療の有力な選択肢たりうることを示している。

We treated 34 eyes with impending macular hole or stage 3 hole by laser photocoagulation. The cases included 9 eyes with macular hole of stage 1B (macular cyst), 14 eyes of stage 2 (cyst with break) and 11 eyes of stage 3. We used dye laser of 590 or 610 nm placed 200 to 300μm away from the edge of the hole. The laser burns averaged 10 in each eye.

The pretreatment visual acuity ranged from 0.2 to 1.0 in 9 eyes with stage 1B holes. After 12 months, visual acuity improved in 4 eyes and stayed the same in 5 eyes. These eyes maintained at least 0.4 of vision. No eye progressed to stage 3 aftertreatment. The pretreatment visual acuity ranged from 0.04 to 0.7 in 14 eyes in stage 2. Visual acuity improved in 2 eyes and remained unchanged in 12. In both groups, visual improvement started 1 to 2 weeks after treatment associated by flattening of the protruded edge of impending holes. No benefi-cial effect was noted in 10 of 11 eyes in stage 3.

Laser photocoagulation thus improved visual acuity and prevented progression to stage 3 in impending macular holes at a high incidence. This therapeutic modality is advocated as an alternative to vitrectomy in impending macular holes.