裂孔原性網膜剥離の強膜内陥術後に生ずる黄斑雛嚢形成

Macular pucker following scleral buckling surgery for rhegmatogeous retinal detachment

　最近5年間に当科で強膜内陥術を行った裂孔原性網膜剥離880眼中，37眼（4.2％）に黄斑雛襞が術後に発生した。50歳以上，無水晶体眼，深部弁状裂孔，上側象限の大きい複数裂孔，術前の硝子体出血や脈絡膜剥離，輪状締結術や網膜下液排液実施例、複数の手術，術後の硝子体や網脈絡膜の出血，脈絡膜剥離，新裂孔形成は網膜剥離術後に発生する黄斑雛襞の危険要因であった。黄斑雛襞は網膜剥離術後平均5.5週で発生した。23眼（62％）に網膜上膜切除術を行い，21眼（91％）では視力が改善し，硝子体手術成績は良好であった。網膜剥離術後に黄斑雛襞が発生すると最終視力は不良なので，手術侵襲を少なくして黄斑綴襞発生を防ぐことが重要である。

We performed scleral buckling surgery for rhegmatogenous retinal detachment on 880 eyes during the past 5 years. Postoperative macular pucker developed in 37 eyes (4.2%) . We identified the following factors as contributing to the macular pucker : age of patients over 50 years, deeply located retinal break, large and multiple retinal tears, superior location of retinal break, presence of vitreous hemorrhage or choroidal detachment prior to surgery, scleral encircling procedure, drainage of subretinal fluid, multiple surgeries, and postoperative complications including vitreous or chorioretinal hemorrhage, choroidal detachment and formation of new retinal break. The macular pucker developed after an average of five weeks of surgery. Surgical removal of epiretinal membrane was performed on 23 eyes, of which 21 eyes (91%) showed improved visual acuity. Still, the final visual acuity in these eyes were significantly worse than eyes without macular pucker. In order to prevent postsurgical macular pucker, we advocate careful surgical manipulations with minimal damage and inflammatory reaction.