近視性黄斑円孔網膜剥離と後部硝子体皮質前ポケット

Posterior precortical vitreous pocket in myopic retinal detachment with macular hole

　近視性黄斑円孔網膜剥離の後極部剥離網膜の網膜前膜様組織を硝子体手術術前・術中に検討し，この病因を検討した。対象は男性1眼，女性9眼の連続10眼，年齢は54〜85歳（平均65.2歳）であった。硝子体手術前に2眼でガス注入術が行われていた。術前，Weiss ringを認める後部硝子体剥離は10眼中8眼でみられた。硝子体手術前に網膜前膜様組織は5眼にみられ，手術中に残り5眼中4眼で後部硝子体皮質の癒着が確認された。この組織を剥離して9眼（90％）で初回の硝子体手術で網膜は復位した。網膜上の膜様組織は硝子体皮質の遺残（後部硝子体皮質前ポケットの後壁）組織であり，近視性黄斑円孔網膜剥離は円孔の接線方向の牽引と長い眼軸や網脈絡膜萎縮などの近視性変化によって生じると考えた。

We reviewed 10 myopic eyes of retinal detachment with macular hole treated by vitreous surgery. This consecutive series comprised 1 male and 9 females. The ages ranged from 54 to 85 years, average 65 years. Intravitreal gas injection had been performed before surgery in 2 eyes. Prior to surgery, posterior vitreous detachment with Weiss ring was present in 8 eyes. Preretinal membrane was present in 5 eyes. During surgery, posterior vitreous cortex was adherent to the retinal surface in 4 of the remaining 5 eyes. Retinal reattachment was obtained in 9 eyes after removal of the preretinal membrane during the initial surgery. The preretinal membranous tissue was supposed to be the residual vitreous cortex which is also identical to the posterior wall of the posterior precortical vitreous pocket as claimed by Kishi. Myopic retinal detachment with macular hole appeared to be caused by tangential traction to the fovea, by elongated axial length and by chorioretinal atrophy.