切迫黄斑円孔および早期黄斑円孔の手術成績

Prophylactic vitrectomy for macular holes

　黄斑円孔の予防手術を24例25眼に行い，術後6〜36か月，平均17か月経過をみた。切迫黄斑円孔（Stage 1b）10眼と早期黄斑円孔（Stage2）15眼で，後者をA群（小穿孔巣＋，fluid cuff−）4眼とB群（大穿孔巣＋，fluid cuff＋）11眼に分けた。術中にStage 2 B群の2眼に黄斑円孔が生じたが，術後に黄斑円孔が生じた例はなかった。術後核白内障進行が18眼72％にみられた。視力を相乗平均で示すと，Stage 1b群は術前0.47で術後0.62,Stage 2A群は術前0.22で術後0.49と改善したが，Stage 2B群は術前0.22で術後は0.21とやや悪化した。切迫黄斑円孔および小穿孔巣＋だがfluid cuff−の早期黄斑円孔に手術的後部硝子体膜剥離は有効な方法と判断された。

Vitreous surgery was performed in 25 eyes with impending or early macular hole by peeling of the posterior vitreous membrane. Presurgical biomi-croscopic examination showed no epiretinal mem-brane or surface wrinkling retinopathy throughout the series. In 10 eyes with impending macular hole at stage 1b, the visual acuity averaged 0.47 before surgery and 0.62 6 months after surgery. In 4 eyes with early macular hole at stage 2 with small eccentric dehiscences but no fluid cuff, the visualacuity averaged 0.22 before and 0.61 after surgery.In 11 eyes with early macular hole with a large dehiscence and fluid cuff, the visual acuity aver-aged 0.22 before and 0.21 after surgery. Intraoper-ative macular hole formed in 2 eyes with early macular hole and large dehiscence. There was no instance of macular hole formation after surgery during the follow up for 6 to 36 months. Eccentric small dehiscences closed in 3 out of 4 operated eyes.