黄斑円孔に対する硝子体手術の成績

Outcome of vitreous surgery for macular hole

　黄斑円孔49例50眼に後部硝子体膜または黄斑上膜剥離とガスタンポナーデを行い，有水晶体眼には超音波水晶体乳化吸引と眼内レンズ嚢内固定を同時に行った。再手術例を含めて36眼72％で円孔の閉鎖消失を得，そのうち24眼67％に2段階以上の視力改善を，11眼31％に0.5以上の視力を得た。円孔閉鎖は，①stage 3では30眼中24眼80％，stage 4では20眼中12眼60％，②推定発症後期間1年未満では22眼中21眼96％，1年以上では28眼中15眼54％，③非陳旧性では40眼中32眼80％，陳旧性では10眼中4眼40％，④円孔直径が0.2乳頭径（DD）では10眼全例100％，0.3DDでは22眼中18眼82％，0.4DD以上では18眼中8眼44％であった。術後視力は，発症後期間が短く，直径が小さく，陳旧性でなく，術前視力が良いほど良かった。

We evaluated the outcome in 50 eyes with full-thickness macular hole treated by pars plana vitrectomy, peeling of posterior vitreous membrane or epiretinal membrane around the hole and gas tamponade. In 48 phakic eyes, phacoemulsification with posterior chamber lens implantation was also performed. The followed up ranged from 3 to 36 months, mean 5.5 months. Closure of macular hole, or success, was obtained in 36 eyes, 72%, including 5 eyes operated twice. Visual acuity improved by 2 lines or more in 24 eyes, 67%. Final visual acuity was 20/40 or better in 11 eyes, 31%. Success was obtained in 24 of 30 stage 3 eyes, 80%, and in 12 of 20 stage 4 eyes, 60%. Success was obtained in 21 of 22 eyes when the duration of less than 1 year, and in 15 of 28 eyes with longer duration. Success was obtained in 32 of 40 eyes without proliferation under the fluid cuff and in 4 of 10 eyes with proliferation. Postoperative visual acuity was better in eyes with duration of symptoms shorter than 1 year, shorter period after hole formation, size of macular hole less than 0.3 disc diameters and better preoperative visual acuity.