網膜中心静脈閉塞症に併発する黄斑浮腫に対する内境界膜剝離

Peeling of internal limiting membrane for macular edema secondary to central retinal vein occlusion

　網膜中心静脈閉塞症に併発した黄斑浮腫78例78眼に硝子体手術を行った。発症から3か月以内の45眼を新鮮例，それ以上の33眼を遷延例とした。37眼では内境界膜を剝離し，41眼では剝離しなかった。黄斑浮腫吸収までの平均期間は，新鮮例で内境界膜を剝離した23眼では6.0月，剝離しない22眼では4.6月で，有意差はなかった（p＝0.31）。同じく遷延例で内境界膜を剝離した14眼では3.9月，剝離しない19眼では7.9月で，有意差はなかった（p＝0.057）。LogMAR視力の改善度は，新鮮例での内境界膜剝離眼では0.32，非剝離眼では0.19で，有意差はなかった（p＝0.41）。同じく遷延例での内境界膜剝離眼では0.29，非剝離眼では0.21で，有意差はなかった（p＝0.60）。重回帰分析で，内境界膜を剝離することは浮腫吸収と術後視力に対する有意な因子ではなかった。網膜中心静脈閉塞症に併発した黄斑浮腫への硝子体手術では，内境界膜剝離は視力改善効果はない。

　Purpose：To evaluate the effect of peeling of internal limiting membrane（ILM）in vitrectomy for macular edema secondary to central retinal vein occlusion. Cases and Method：Consecutive series of 78 eyes in 78 patients was reviewed. They comprised 45 eyes operated within 3months of onset（early cases）and 33 eyes operated later（persistent cases）. ILM peeling was performed in 37 eyes and not in 41 eyes. Findings：In 45 early cases,macular edema subsided after an average of 6.0months in 23 eyes that received ILM peeling and 4.6months in the other 22 eyes. The difference was not significant（p＝0.31）. In 33 persistent cases,macular edema subsided after an average of 3.9months in 14 eyes that received ILM peeling and 7.9months in the other 22 eyes. The difference was not significant（p＝0.41）. In early cases,logMAR visual acuity improved by 0.32 in eyes that received ILM peeling and by 0.19 that did not. In persistent cases,it improved by 0.29 in eyes that received ILM peeling and by 0.21 that did not. The difference was not significant（p＝0.60）. ILM peeling was not a significant factor in the absorption of macular edema or postoperative visual acuity by multiple regression analysis. Conclusion：ILM peeling does not significantly improve the outcome of vitrectomy for macular edema.