黄斑剝離を伴う裂孔原性網膜剝離の術前OCTと視力予後の相関

Correlation between OCT findings and postoperative visual acuity in foveal-splitting rhegmatogenous retinal detachment

要約　目的：裂孔原性網膜剝離（RRD）が進行し黄斑剝離を生じた場合，どこまで剝離が進行すれば視機能が不良になるかは明らかでない。今回，光干渉断層計（OCT）にて黄斑剝離を認めたfoveal-splitting RRD（fsRRD）に対し中心窩からの剝離範囲と視力予後の相関について後ろ向きに検討を行った。

対象と方法：2016年3月〜2022年8月に関西医科大学附属病院を受診し，その翌日までに硝子体手術を行ったfsRRD 43例44眼。中心窩からの剝離範囲に応じて，foveal RD（f）群とperifoveal RD（p）群とmacula RD（m）群の3つに分け，術前後の視力，術前のRRD丈について評価した。

結果：症例内訳は，f群17眼，p群16眼，m群11眼。logMAR視力の推移は，f群0.097，0.046，−0.079，−0.079，p群0.523，0.126，0.000，0.000，m群0.699，0.155，0.000，0.155（術前，術後1，3，6か月の値）であり，f群はm群と比較して，すべての観察点で有意に視力良好であった（p＜0.05）。術前RRDの丈（μm）はf群249，p群688.5，m群782とf群がm群と比較して有意に低かった。

fsRRDは進行する前に手術することで視力予後が改善する。術前OCT画像は術後視力評価に有用である。

Abstract　Objective：When rhegmatogenous retinal detachment（RRD）progresses to involve the macular area, visual outcome after operation tends to be very poor. The relationship between the distance of the detached retina from the fovea and the visual progress after treatment. Therefore, in this study, we aimed to retrospectively assess the correlation between the extent of detachment from the central fovea to the detachment frontline and visual prognosis in foveal-splitting RRD（fsRRD）with macular detachment using OCT.

Subjects and Methods：We included 44 eyes of 43 patients with fs RRD who underwent vitrectomy 1 day after the first visit between March 2016 and August 2022. Patients were divided into three groups according to the extent of the detached retina from the fovea, as follows：foveal RD（f）, perifoveal RD（p）, and macular RD（m）and were evaluated for pre and postoperative visual acuity and preoperative RRD length.

Results：There were a total of 17 eyes in group f, 16 eyes in group p, and 11 eyes in group m. The logMAR visual acuity trends preoperatively and 1, 3, and 6 months postoperatively were 0.097, 0.046, −0.079, and −0.079, 0.523, 0.126, 0.000, and 0.000, and 0.699, 0.155, 0.000, and 0.155 in group f, p, and m, respectively, and group f had significantly better visual acuity up to 6 months postoperatively compared to that of group m（p＜0.05）. Preoperative RRD height was 249μm in group f, 688.5μm in group p, and 782μm in group m. Group f had significantly lower RRD height than that of group m.

Conclusions：Early surgery for fsRRD may improve visual prognosis, and preoperative OCT imaging is useful for postoperative visual acuity assessment.