乳頭ピット黄斑症候群に併発した全層黄斑円孔に対し硝子体手術および網膜光凝固術を施行した1例

A case of vitreous surgery and retinal photocoagulation for macular hole secondary to optic disc pit-macular syndrome

要約　目的：乳頭ピット黄斑症候群に併発した黄斑円孔に対して硝子体手術および網膜光凝固術（PC）を施行した症例を報告する。

症例：79歳，男性。近医にて左眼黄斑円孔と診断され，当院を紹介され受診となった。左眼矯正視力は0.1で，眼底には乳頭小窩と乳頭から黄斑部にかけての網膜分離と全層黄斑円孔を認めた。以上から，黄斑円孔を伴った乳頭ピット黄斑症候群と診断し，白内障手術併用硝子体手術を施行した。手術では，後部硝子体剝離の作成および人工的に剝離を行った内境界膜（ILM）を黄斑円孔と乳頭ピットに充塡し，ガスタンポナーデを施行した。術後，黄斑円孔は中心窩網膜上縁で閉鎖するも外層黄斑円孔と網膜分離は残存した。術2か月後と4か月後に視神経乳頭耳側縁にPCを施行し，網膜分離は軽減したが，黄斑円孔は再発した。その2か月後に黄斑円孔は自然閉鎖し，矯正視力は0.3となった。

結論：黄斑円孔を伴う乳頭ピット黄斑症候群に対して，ILM移植併用硝子体手術と乳頭耳側縁へのPCの併用が有用と考えられた。

Abstract　Purpose：To report a case of vitreous surgery and retinal photocoagulation for macular hole（MH）secondary to optic disc pit-macular syndrome.

Case：A MH was diagnosed in the left eye of a 79-year-old male patient by a local ophthalmologist, and the patient consulted the Kansai Medical University Hospital. The best corrected visual acuity of the left eye was 0.1. His left eye showed optic disc pit, retinoschisis in the papillomacular area, and a full-thickness macular hole. It was diagnosed as pit-macular syndrome accompanied by secondary MH and underwent vitreous surgery combined with cataract surgery（creation of a posterior vitreous detachment and filled to the MH and a pit detached internal limiting membrane, followed by gas tamponade）. Postoperatively, the MH closed at the superior limbus of the central fovea, but the outer MH and retinal separation remained. Retinal photocoagulation was performed on the edge of the optic nerve papilla 2 and 4 months after surgery, and this reduced the retinal separation, but the MH recurred afterward. Two months after the MH recurrence, it closed spontaneously and his BCVA increased to 0.3.

Conclusion：The combination of vitrectomy with internal limiting membrane transplantation and retinal photocoagulation to the edge of the optic nerve appeared to be useful for the treatment of pit macular syndrome accompanied by the MH.