沿血管裂孔網膜剥離の特徴

Characteristics of retinal detachment due to paravascular tears

　沿血管裂孔網膜剥離についてその頻度と特徴を調べた。過去24か月間に当科で手術を行った裂孔原性網膜剥離308例317眼中，沿血管裂孔は24例24眼（7.6％）を占め，年齢は46〜82（64.7±9.4）歳，男女比は10：14であった。裂孔の位置は上方に多く（70.8％），大きさは1／3〜3（平均0.74）乳頭径であった。裂孔の成因は網膜硝子体癒着と後部硝子体剥離で，正視から中等度近視で周辺部から中間部に裂孔を形成するものと，強度近視を伴い後極部に裂孔を形成するものの2型に分けられた。治療には裂孔の閉鎖とともに硝子体の牽引の除去が必要であり，周辺部裂孔には強膜バックリング，やや深部の裂孔には子午線プロンベ縫着術，深部裂孔には硝子体手術が有効であった。

We surgically treated 317 eyes of rhegmatogenous retinal detachment during the foregoing two years. Paravascular retinal tear was causative lesion in 24 eyes, 24 patients (7.6%). There were 10 males and 14 females. The ages ranged from 46 to 82, average 65 years. The paravascular tear was located in the superior hemisphere in 17 eyes, 71%. Their size ranged from 0.33 to 3 disc diameter (DD), average 0.74 DD. The tear was caused by vitreoretinal adhesion and posterior vitreous retinal detachment. There were two definite groups. Paravascular tear was either located in the peripheral to the midperipheral fundus in eyes with emmetropia or minimal to moderate myopia, or in the posterior fundus area in eyes with high myopia. It was necessary to close the tear and to remove vitreoretinal adhesion. Tears in the periphery were effectively treated by scleral buckling surgery. Radial buckling with scleral plomb was effective for more posteriorly located tear. Vitreous surgery was effective for tears in the posterior fundus.