黄斑浮腫に対する硝子体手術導入後の網膜静脈分枝閉塞症新鮮例の治療と成績

Outcome of vitrectomy for macular edema in branch retinal vein occlusion in its early stage

（R2-7PM−4）　発症から6か月以内の網膜静脈分枝閉塞症に併発した黄斑浮腫に対しての治療成績を検索した。52例52眼を黄斑浮腫の程度によって3群に分け，軽度群には内服治療，中等度群にはレーザー光凝固，高度群にはレーザー光凝固と硝子体手術を行った。軽度群14眼では，0.8以上の最終矯正視力が全例で得られた。中等度群20眼では，0.7以上の視力が18眼（90％）で得られた。高度群で硝子体手術を施行した15眼では，黄斑浮腫が1〜8か月（平均4.2か月）で消失し、0.7以上の視力が7眼（53％），0.5以上の視力が12眼（80％）で得られ，全例で0.3以上の視力が得られた。高度群で手術ができなかった3眼では，最終視力は0.2以下であった，網膜静脈分枝閉塞症に併発した黄斑浮腫がレーザー光凝固で改善しない症例には，硝子体手術が有効でありうる可能性が示唆された。

We reviewed the clinical course of macular edema which developed within 6 months after onset of branch retinal vein occlusion. The series comprised 52 eyes of 52 patients. Cases with mild macular edema were treated by medication only. Cases with moderate edema underwent laser photocoagulation. Cases with severe edema received additional vitrectomy. All the 14 eyes with mild macular edema resulted in visual acuity of 0.8 or more. In 20 eyes with moderate macular edema 18 eyes (90%) resulted in visual acuity of 0.7 or more. In 15 eyes with severe macular edema, surgery induced resolution of macular edema in 1 to 18 months, average 4.2 months. Visual acuity of 0.7 or more was obtained in 7 eyes (53%) , 0.5 or more in 12 eyes (80%), and all the 15 eyes resulted in visual acuity of 0.3 or more. Three eyes with severe macular edema did not undergo surgery. The final visual acuity in these 3 eyes was 0.2 or less. The findings show that vitrectomy may induce resolution of macular edema with improved visual acuity in severe cases resistant to photocoagulation.