裂孔原性網膜剥離に対する強膜内陥術後に発生した脈絡膜剥離

Choroidal detachment following scleral buckling surgery for retinal detachment

　裂孔原性網膜剥離880眼への強膜内陥術後に，脈絡膜剥離が66眼7.5％に生じた。高齢の男性の深部弁状裂孔による胞状網膜剥離に対して輪状締結術を行った場合に脈絡膜剥離が発生しやすく，強膜内陥材料による渦静脈の圧迫が原因と思われた。脈絡膜剥離は術後約3日目に発生し，約8日続いて自然消退したが，副腎皮質ステロイド薬の内服が脈絡膜剥離の消退に有効であった。網膜の復位には複数回の手術を要したが，退院時の網膜剥離復位が全例で得られた。脈絡膜剥離が生じた眼では，これがない眼に比べて，増殖性硝子体網膜症や黄斑皺襞形成などの眼内増殖性変化，および毛様体剥離による浅前房から続発閉塞隅角緑内障の合併が多かった。

We performed scleral buckling surgery as the primary procedure in 880 eyes of rhegmatogenous retinal detachment. Serous choroidal detachment developed in 66 eyes, 7.5%. It was more frequent in aged persons, males and bullous retinal detachment due to posteriorly located retinal breaks. Compression of the vortex veins due to buckling material appeared to be the main causative factor. The choroidal detachment appeared on the third postoperative day, continued for an average of eight days and spontaneously disappeared by the end of the second postoperative week. Systemic corticosteroid was effective for choroidal detachment. Repeated surgeries were necessary but final retinal reattachment was obtained in all the eyes. Eyes with choroidal detachment showed a higher incidence of macular pucker, proliferative vitreo-retinopathy and angle-closure glaucoma due to shallow anterior chamber with edema of the ciliary body than those without.