術中OCTおよび眼内内視鏡を併用したheads-up硝子体手術

Heads-up vitreoretinal surgery with additional intraocular endoscopy and intraoperative optical coherence tomography

要約　目的：Heads-up硝子体手術を経験したので報告する。

対象と方法：当科において2016年4〜6月に，術中光干渉断層計（OCT）を搭載した手術顕微鏡を用いてheads-up硝子体手術を施行した症例を対象とした。

結果：症例は23例24眼で，増殖糖尿病網膜症8眼，黄斑上膜2眼，黄斑円孔7眼，黄斑円孔網膜剝離2眼，裂孔原性網膜剝離2眼などであった。必要に応じて術中OCTおよび眼内内視鏡を併用した。いずれの症例も予後は良好で重大な合併症はなかった。Heads-up硝子体手術ではモニターを見ながら手術を行うため，OCTおよび内視鏡のモニター観察への移行がスムーズであった。白内障手術では焦点の微調整が煩雑で良好な立体視を得るのが困難であった。

結論：Heads-up手術は硝子体手術では術中観察に支障はなく遂行できたが，白内障手術では顕微鏡の鏡筒を通して見る場合と比較して立体感が異なるため，手術施行に若干の困難が感じられた。

Abstract　Purpose：To report the outcome of heads-up vitreoretinal surgery.

Cases and Method：Surgery was performed by one surgeon while looking at the three-dimensional videoscopic monitor, or heads-up method. A total of 24 surgeries were performed during a 3-month period. The series comprised proliferative diabetic retinopathy 8 eyes, idiopathic macular hole 7 eyes, macular hole retinal detachment 2 eyes, epiretinal membrane 2 eyes, central retinal vein occlusion with vitreous hemorrhage 1 eye, and endophthalmitis one eye. Cataract surgery was performed on 13 eyes. Endoscopy was occasionally used intraoperatively.

Results：The course during and after surgery was favorable with no major complications. Heads-up surgery allowed the surgeon to operate by only looking at the display terminal and, additionally, to use accessory tools as optical coherence tomography or endoscopy. Frequent adjustment of image focusing was necessary in cataract surgery, resulting in difficulty to obtain stereoscopic field.

Conclusion：Heads-up method was useful in vitreoretinal surgery. There was no apparent no merit for cataract surgery.