黄斑円孔術後再開例の検討

Review of reopening of macular holes after initially successful surgery

　同一術者が連続して行った黄斑円孔手術例594眼中，同手術により閉鎖した553眼中で再開した31例32眼（5.8％）を対象として，臨床像と視力予後を検討した。内訳は男性が9例9眼（28％），女性が22例23眼（72％）で，黄斑円孔の両眼性が8例（26％）あった。再再開例が3眼，再再再開例が1眼であった。初回手術前の平均視力は0.19，再開前は0.53，再開後が027であった。再開後の手術例の25眼中23眼（92％）が閉鎖し，平均視力は0.41に改善した。再手術をしなかった7眼の平均視力は0.26を維持した。以上のように，黄斑円孔再開例には女性と両眼性が多かった。再開例に対する手術は有効であったが，再開前視力には戻らなかった。再開のより少ない術式が求められる。

We reviewed consecutive 594 eyes of surgically treated idiopathic macular hole with particular attention to reopening after initial hole closure. All the eyes had been operated on by one surgeon. Initial hole closure was obtained in 553 eyes, of which the hole reopened in 32 eyes (5.8%). These 32 eyes comprised 9 eyes (28%) of 9 males and 23 eyes (72%) of 22 females. There were 8 bilateral cases (26%). Reopening of macular hole occurred twice in 3 eyes and three times in one. The visual acuity averaged 0.19 before surgery, 0.53 before reopening and 0.27 after reopening. After reopening, 25 eyes underwent additional surgery. The hole was closed in 23 eyes (92%) resulting in visual acuity averaging 0.41. In the other 7 eyes which did not receive additional surgery, the averaged visual acuity remained at 0.26. The findings show that reopening of macular hole is more common in females and in bilatelal cases. Additional surgery was effective but the visual acuity was poorer than before reopening.