黄斑円孔手術後に生じた重篤な視力障害

Severe visual loss following macular hole surgery

　特発性黄斑円孔に対するビトレクトミー，SF₆ガス注入術施行後に，著明な視力低下を来した2症例について検討した。症例1は65歳男性。術後7日目に視力低下を訴え，視力は手動弁に低下した。視野検査にて中心暗点を認め，眼底に著明な網膜血管の狭細化を認めた。症例2は66歳女性。術後10日目に視力は手動弁に低下，眼底に網膜動静脈の著明な狭細化および周辺部の網脈絡膜萎縮を認めた。2症例とも術中に合併症を認めず，術後眼圧は正常，円孔は術2週間後にはほぼ閉鎖していた。これらの症例に認められた変化は，術後に生じた網脈絡膜，および視神経の循環障害に起因すると推測された。

A 65-year-old male with stage 3 macular hole was treated by vitreous surgery with SF₆ gas injection. One week later, the visual acuity was hand movements with central scotoma. Retinal vessels had become extremely narrow. Fluorescein angiography showed delayed filling of retinal vessels. Another 66 -year-old female with reopening of macular hole was treated by residual vitreous removal and SF₆ gas injection. The visual acuity was hand movements two days later. Most of the retinal and choroidal vessels had become extremely narrow. Fluorescein angiography showed widespread chorioretinal atrophy along the superior and inferior vascular arcades. In both cases, the macular holes closed within two weeks. The intraocular pressure was within normal range throughout. A sudden failure in retinal and choroidal circula-tion appeared to be the cause of postoperative visual loss in these cases. The exact mechanism is unclear.