裂孔原性網膜剥離に対する経強膜的手術の初回非復位眼の検討

Evaluation of failure cases after initial retinal detachment surgery

　1987年1月から1990年12月の期間に初回経強膜的手術を行った裂孔原性網膜剥離761眼の初回非復位眼について追加術式，復位率，および合併症について検討した。初回復位は655眼（86.0％），最終復位は738眼（97.0％）であった。初回復位率は黄斑型で最も悪く（64.6％），次いで中間型（76.1％）であった。黄斑型では空気注入追加のみによって13眼中10眼に復位が得られ，黄斑プロンベ＋空気注入により初同復位率の向上が期待できた。強膜通糸時の眼球穿孔や，下液排液時の脈絡膜出血は黄斑型（33.3％），中間型（19.6％）に多く発生した。中間型では初回非復位眼での硝子体手術の頻度が高く手術合併症も比較的多く，症例によって初回より硝子体手術を行ってもよいと考えられた。

We reviewed 761 eyes which underwent conven-tional retinal detachment surgery during the fore-going 4-year period. The retina was reattached in 655 eyes, 84%, after the first surgery and in 738 eyes, 97%, after multiple surgeries. The rate of failure after the first surgery depended on the type and location of retinal break: 15% for eyes with oral break, 14% for peripheral tear, 5% with periph-eral hole, 24% for midperipheral break and 35% for macular hole. We performed submacular scleral indentation with explant for eyes with macular hole. Out of 17 eyes which failed to be reattached, 10 eyes were cured with intravitreal air injection and 4 eyes with vitrectomy. There was a higher incidence of scleral perforation or choroidal bleed-ing in eyes with macular hole than midperipheral retinal break at 33% and 20% respectively. Prolifer-ative retinopathy developed in 25% of eyes with midperipheral break after the initial surgery failed. From these findings, we advocate combined surgery with macular explant and intravitreal air in eyes with macular hole. Selected cases of midperipheral breaks would have to be treated with vitrectomy as the initial procedure.