外傷に伴う網膜剝離の臨床像と手術成績の検討

Clinical features and surgical outcome of traumatic retinal detachment

目的：外傷性網膜剝離の臨床像と手術成績の検討。対象：過去9.5年間に外傷性網膜剝離の自験例57例58眼を対象とした。男性41例42眼，女性16例16眼，年齢は12～85歳（平均46歳）である。結果：外傷は非開放性が28眼で，すべて打撲が原因であった。開放性は30眼で，破裂19眼，裂傷6眼，異物5眼であった。打撲は若年男性のスポーツ外傷が多く，破裂は高年者の転倒，裂傷と異物は壮年男性の労働事故が多かった。網膜の復位は，打撲では93％，破裂では38％，裂傷と異物では80％で得られた。外傷が非開放性であり，網膜剝離の範囲が3象限以下，術前視力が0.01以上のとき，0.1以上の最終視力が得られる率が有意に高かった。結論：外傷に伴う網膜剝離では，開放性かつ眼球破裂がある症例では予後が不良である。硝子体手術は診断的および治療的に重要である。

Purpose：To report clinical features and surgical outcome of traumatic retinal detachment. Cases：This retrospective study involved 58 eyes of 57 cases of traumatic retinal detachment. The series comprised 42 eyes of 41males and 16 females. The age ranged from 12 to 85 years,average 46 years. Results：Closed eye injury was present in 28 eyes. All were due to contusion. Open eye injury was present in 30 eyes,including eyeglobe rupture 19 eyes,penetrating injury 6 eyes,and foreign body 5 eyes. The retina became reattached in 93％ of eyes with contusion,38％ of eyes with rupture,and 80％ each in eyes with penetrating injury or foreign body. Visual outcome of 0.1 or better was obtained when injury was caused by contusion,retinal detachment involved 3 quadrants or less,or visual acuity was 0.01 or better. Conclusion：In traumatic retinal detachment,visual outcome is poor in cases with open eye injury or eyeglobe rupture. Vitreous surgery may be beneficial in the diagnosis and treatment.