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巨大裂孔網膜剥離9 例9 眼を過去4 年間に経験し,手術手技と成績について検討したので報告する.裂孔の大きさは180 度が2 眼,120 度が4 眼,100 度が1 眼,90 度が2 眼であった.全症例に初回手術として経毛様体扁平部硝子体手術(PPV)を行った.輪状締結術(EN)併用が7 眼で,液体パーフルオロカーボン(PFCL)を用いたものは6 眼,タンポナーデ物質はシリコーンオイル(SO)が5 眼,空気が4 眼であった.超音波水晶体乳化吸引術(PEA)を施行したものは7 眼であった.初回非復位例はPEA+PPV にEN 併用し,PFCL-空気置換した大きさ120 度の2 眼であり,網膜の後極へのずれ落ちを生じていた.網膜のずれ落ちは裂孔周囲の硝子体の切除やPFCL-空気置換の際に網膜下液の吸引が不十分な可能性があった.再手術としてPPVおよびPFCL-SO 置換で復位した.初回復位率は9 眼中7 眼(77.8%),最終復位率は9 眼中9 眼(100%)であった.術後合併症に網膜前膜が2 眼,一過性眼圧上昇が2 眼,後発白内障が1 眼あり,視力改善の妨げの要因になるので注意が必要であった.当院における巨大裂孔網膜剥離の手術成績はおおむね良好であった.

We treated 9 patients with 9 giant retinal tears in the last 4 years. We report the surgical techniques used for these patients and the results of surgery.The size of the tear was 120 degrees in 4 eyes, 180 degrees in 2 eyes, 90 degrees in 2 eyes, and 100 degrees in 1eye. Pars plana vitrectomy(PPV)was performed as the primary surgery for all the patients. Encircling(EN)was performed for 7 eyes. Perfluorocarbon liquid(PFCL)was used for 6 eyes. Silicone oil(SO)was used as tamponadematerial for 5 eyes, and air tamponade was used for 4 eyes.Phacoemulsification and aspiration(PEA)was used for 7eyes. Retinal attachment was unsuccessful for 2 eyes where surgery was combined with PEA, PPV, EN and PFCL-airreplacement. This led to a shift down to the posterior pole of the retina. The shift down of the retina was possibly caused by removal of the vitreous around the tears and inadequateaspiration of subretinal fluid during PFCL-air exchange.PPV and PFCL-SO replacement were performed as the second surgery. The retina could be reattached in 7 of9(77.8 %)eyes for the primary surgery. The final retinalreattachment rate was 100%.After the primary and second surgery, epimacular membranesdeveloped in 2 eyes, transient intraocular pressureincrease was noted for 2 eyes, and posterior capsule opacificationwas noted in 1 eye. Our results indicate that surgeonsshould be careful about postoperative complicationsthat affect visual prognosis.The surgical results at our hospital for giant retinal tearswere almost good.


  • Dokkyo journal of medical sciences

    Dokkyo journal of medical sciences 39(2), 113-117, 2012-07-25


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    journal article
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    NII-ELS  IR 
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