硝子体切除術，組織プラスミノーゲンアクチベータとガス注入術を併用した黄斑下血腫移動術

Management of submacular hemorrhage with vitrectomy, intravitreal tissue plasminogen activator and pneumatic displacement

（P−2-107）　黄斑下血腫に対し硝子体切除術，組織プラスミノーゲンアクチベータ（tPA）とガス注入術を併用した黄斑下血腫移動術を行った。対象は加齢黄斑変性症5眼，網膜細動脈瘤6眼で，術式は硝子体切除後，tPAを25〜62.5μg,SF₆またはC₃F₈を硝子体腔に注入し，術後3時間仰臥位ののち24時間伏臥位を施行した。加齢黄斑変性症5眼の全例で血腫の移動が認められたが，網膜細動脈瘤3眼では移動がなかった。術翌日に加齢黄斑変性症1眼，網膜細動脈瘤5眼で硝子体出血が認められ，加齢黄斑変性症1眼，網膜細動脈瘤4眼に硝子体再手術を施行した。本術式では網膜細動脈瘤において術後硝子体出血が生じる可能性が高く，その適応は慎重に検討する必要がある。

We surgically treated 11 eyes of submacular hemorrhage secondary to age-related macular degeneration E eyes and retinal arteriolar macroaneurysm 6 eyes. Following pars plana vitrectomy, the vitreous was injected with tissuc plasminogen activator (25-62.5 gg) and expansile gas (sulfur hexafluoride or perfluoropropane) . The patients ther remained in supine position for 3 hours and in prone position for another 24 hours. The submacular hemorrhage waE displaced in all the eyes of macular degeneration and in 3 eyes of macroaneurysm. Vitreous hemorrhage developed in 1 eye in the former and in 5 eyes in the latter. Vitrectomy had to be performed in 5 of these 6 eyes. This findings show thal this surgical modality involes the risk of postoperative vitreous hemorrhage and requires due precaution, particularly ir cases secondary to macroaneurysm.