巨大裂孔による網膜剥離の手術術式の検討

Surgical results in retinal detachment with giant breaks

　巨大裂孔による網膜剥離49例52眼について復位率を検討した．6カ月の経過観察で，全体の復位率は56％であった．巨大裂孔が難治となる条件として，アトピーに伴うもの，無水晶体眼に発症したもの，男性，裂孔の大きいもの，反転のあるものがあげられ，反対に外傷性のもの，女性，裂孔が小さく反転の無いものは予後が良かった．手術術式を経強膜手術，硝子体手術，ガスタンポナーデ後経強膜手術の3つに分けて復位率を比べると，反転の無い例ではどの術式も復位率に優劣つけがたく，最も合併症の少ない従来の経強膜手術で良いと思われた．反転のある例，180度を越えるような例では，ガスタンポナーデ後の経強膜法が良い復位率を得ており，現在のところ最も優れた方法と考えられた．巨大裂孔の治療に際しては，裂孔の状態に応じて，なるべく侵襲が少なく復位率の良い方法を選ぶべきである．

We reviewed the surgical outcome in retinal detachment with giant retinal breaks in 52 eyes, 49 cases, during a 14-year period through 1986. The ages ranged from 2 to 64 years, average 31 years. The series included 40 males, 42 eyes, and 9 females, 10 eyes.

Reattachment of the retina resulted in 32 eyes (62%) at 2 weeks after surgery and in 29 eyes (56%) at 6 months. Poor prognostic factors includ-ed a break with atopic dermatitis, aphakia, male, extension of the tear over 180 degrees and tear with rolled posterior retinal flap. Favorable factors in-cluded traumatic giant tear, female, smaller extent of the tear less than 180 degrees and no rolled flap. In eyes with the tear extending less than 180 degrees, there was no difference in the rate of success among three surgical procedures : trans-scleral surgery, vitrectomy, and transscleral surgery after gas tamponade. In eyes with the tear larger than 180 degrees and/or with rolled posterior flap, transscleral surgery after gas tamponade resulted in 100% rate of success.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(5) : 479-483, 1988