硝子体切除，液空気置換による黄斑下血腫移動術

Displacement of submacular hematoma by pars plana vitrectomy and fluid-air exchange

（P−2-104）　63歳男性に右眼の視力低下が突発した。右眼矯正視力は0.1。乳頭縁から中心窩にかけて厚い網膜下血腫があり，加齢黄斑変性によると診断した。発症3日目に硝子体切除術と液空気置換術を行った。血腫は術後3日目から下方に移動しはじめ，視力は術後1週で0.8,1か月で1.0に回復した。併存する網膜色素上皮下血腫には位置の移動はなかった。術後1か月後の黄斑部局所ERGでは，negativeb波のパターンがあり，網膜中層の機能回復が視力回復よりも遅れていることが推定された。新鮮な厚い黄斑下血腫に対して，この手術が有効であることを示す症例である。

A 63-year-old male developed abrupt blurring in his right eye. His corrected visual acuity was 0.1 right. A thick submacular hematoma was present between the disc margin and the fovea in the affected eye. The condition was diagnosed as secondary to age-related macular degeneration. The affected eye was treated by vitrectomy and fluid-air exchange 3 days after onset. The submacular hematoma started to shift inferiorly from the 3rd postoperative day on. The visual acuity improved to 0.8 one week after surgery and to 1.0 another 3 weeks later. The hemorrhage beneath the retinal pigment epithelium, which was also present, remained stationary. Focal macular electroretinogram perfomed one month after surgery showed negative b wave, suggesting that the function in the middle retinal layers persisted longer than recovery in visual acuity. This case illustrates the efficacy of surgery for thick submacular hematoma in its early stage.