網膜剥離の手術法の選択—経強膜もしくは経硝子体の選択

The studies on the choice of surgical approach for complicated retinal detachment

　今回筆者らは，網膜剥離と診断された202眼のうち，裂孔の位置・大きさ・手術既往の有無・牽引の程度・硝子体混濁の程度・PVRの有無などより，難治性と思われる症例を抽出し，その手術方法として，経強膜的アプローチか，経硝子体的アプローチかで苦慮した34眼に対しての，各項目について検討を加えた。また，全例に対して，最終的に硝子体手術を施行し，88％の復位率が得られた。

　裂孔原性網膜剥離の手術の第一選択は，経強膜からのアプローチであるが，今回の筆者らの経験から術後のPVRの予防や視機能などの点から，難治性と思われる症例には，硝子体手術に起因する問題点を理解したうえで，経硝子体法による手術を選択したほうがより良好であると思われた。

Investinaged whether vitreous surgery was supe-rior to conventional approach or not in terms of treatment of so-called complicated retinal detach-ment. The subjects were 34 cases in which it was difficult to make a choice of surgical approach as the first procedure. In order to determine the mode of operation, many factors such as size and locationof retinal break (s), grade of PVR, history of previous operation (s) and grade of vitreous trac-tion were studied.

The final success rate was 88% in cases treated by vitreous surgery. The rate of successful results was much lower in case operated by conventional approach. We conclude that conventional approach should be the first choice, while vitreous surgery is advantageous to get better visual outcome avoiding PVR in cases with deeper retinal breaks than vor-tex vein, and in those with PVR.