特発性黄斑円孔の術後閉鎖過程の光干渉断層計による観察

Process of postoperative repair of idiopathic macular hole observed by optical coherence tomography

要約　目的：光干渉断層計（OCT）による黄斑円孔の術後閉鎖過程の報告。対象と方法：過去33か月の間に硝子体手術を行った黄斑円孔24眼を対象とした。年齢は49～75歳（平均67歳）で，自覚症状出現から手術までの期間は0.5～12か月（平均2.5か月）であった。病期分類は，第2期7眼，第3期9眼，第4期8眼であった。結果：手術から2週間以内のOCT所見で，4眼で中心窩の構造が回復し，13眼で網膜外層に欠損が残り，7眼で円孔縁が陥没し外層が消失していた。視細胞の内外節接合部の欠損はこの順に小さかったが，内外節接合部の改善率と視力回復に有意差はなかった。内外節接合部の改善には外境界膜の修復が先行した。結論：視細胞の内外節接合部の欠損量は，黄斑円孔術後の中心窩の形態を規定する。内外節接合部の改善には外境界膜の修復が先行する。

Abstract.　Purpose：To report the process of postoperative repair of macular hole evaluated by optical coherence tomography（OCT）. Cases and Method：This study was made on 24 eyes that received vitreous surgery in the past 33 months. Age of patients ranged from 49 to 75 years,average 67 years. Interval between onset and surgery ranged from 0.5 to 12 months,average 2.5 months. The series comprised 7 eyes of stage 2,9 eyes of stage 3,and 8 eyes of stage 4. Results：OCT within 2 weeks after surgery showed recovery of foveal structure in 4 eyes,still persistent defect in outer retinal layer in 13 eyes,and absence of outer retinal layer with collapsed edge of hole in 7 eyes. Defective junction between inner and outer segment coincided with the above finding in the ascending order. Defect in the junction was not correlated with rate of improvement of junction or of visual acuity. Repair of defective junction was preceded by that of outer limiting membrane. Conclusion：Amount of defective junction between inner and outer segment of visual cells determines the shape of macular hole after surgery. Improvement in the defective junction was preceded by repair of outer limiting membrane.