黄斑円孔は術後1日で閉鎖する

Macular holes may close one day after surgery

　特発性黄斑円孔20眼に対して，超音波水晶体乳化吸引術と眼内レンズ挿入を併用した硝子体手術を行った。内訳はstage3が12眼，stage 4が4眼，再手術4眼である。術直後から，ガスを通して，アムスラー表を使った検査と近方視力検査を行った。円孔が閉鎖すると，アムスラー表での成績が顕著に改善し，50％では変視症が自覚されなくなる。細隙灯顕微鏡と非接触レンズを使つた黄斑部の観察で円孔の閉鎖が確認できたら，夜間は側臥位にさせた。1回の手術で円孔の閉鎖が得られた19眼のうち，17眼では術翌日に，2眼では2日目には閉鎖を確認した。3眼では円孔が再発し，初回手術の成功率は16眼80％であった。円孔閉鎖が確認できた後，強制体位を緩和しても，閉鎖率には従来の報告と大差がなく，患者の苦痛軽減に有用であった。

We treated 20 eyes of idiopathic macular hole by vitreous surgery, phacoemulsification and aspiration with intraocular lens implantation. The series comprised 12 eyes of stage 3 hole, 4 eyes of stage 4 hole and reopening of the hole 4 eyes. After surgery, the eyes were examined by Amsler chart and for near visual acuity through the intravitreal gas. Results by Amser chart improved immediately after macular hole closure. Metamorphopsia also disappeared in about one half of the cases. The patients were freed from the face-down position during the night after hole closure was confirmed by examination with slitlamp and noncontact lens. Initial closure of macular hole was obtained in 19 eyes. It closed on day 2 of surgery in 17 eyes and on day 3 in 2 eyes. Macular hole reopened in 3 of these eyes, resulting in the success of initial surgery in 16 eyes, 80%. Early relaxation from forced head-down position resulted in the same success rate as reported elsewhere and significantly contributed to the well-being of patients during the postooperative period.