黄斑円孔手術後の長期視力経過

Long-term course of visual acuity following macular hole surgery

　特発性黄斑円孔58例59眼に手術を行い，2年以上の視力経過を検索した。症例は術前・術後の併発症がなく，初回手術で円孔閉鎖が得られたものとした。有水晶体眼には水晶体乳化吸引と眼内レンズ挿入を行った。硝子体ゲル切除後に後部硝子体剥離がなければ作製し，黄斑上膜があれば除去した。内境界膜剥離や網膜色素上皮掻爬は行わなかった。相乗平均視力は，術前0.28，術後1年0.66，最終観察時0.79であり，手術により有意に改善した（p＜0.001），術後1年と最終観察時の視力は，47眼（80％）で改善または不変であり，12眼（20％）で低下した。これら2群間で，術前視力，年齢，円孔径，推定発症期間，屈折についての有意差はなかった。最終経過時の視力に関係する因子は術前視力と年齢であった。黄斑円孔では，術後2年以上にわたって視力が改善・維持される可能性が高い。

We evaluated the course of visual acuity following macular hole surgery in 59 eyes of 58 patients. As inclu-sion criteria, the macular hole closed after a single surgery and all eyes had no complication before or after surgery. All the phakic eyes received phacoemulsification-aspiration with intraocular lens implantation. After core vitrectomy, pos-terior vitreous detachment was created followed by removal of epiretinal membrane whenever present. We performed no removal of internal limiting membrane nor scraping of retinal pigment epithelium. The geometrical mean of visual acuity improved from 0.28 before surgery to 0.66 one year after surgery and 0.79 after 2 years or longer (p＜0.001). The final visual acuity improved or remained unchanged from the value at one year after surgery in 47 eyes (80%) and deteriorated in 12 eyes (20%). There were no differences between the two groups regarding preoperative visual acuity, age, size of macular hole, duration until surgery, or refraction. The final visual acuity was significantly corre-lated with preoperative visual acuity and age. The findings show that macular hole surgery may improve the visual acu-ity for 2 years or longer.