成相 由依

INTRODUCTION: The ability to reduce illumination levels is generally accepted as one of the main benefits of a three-dimensional heads-up system (3D system: Ngenuity®; Alcon, CA, USA). Some studies have focused on illumination reduction in vitreoretinal procedures; however, information regarding illumination reduction in cataract surgery has not been published. PURPOSE: This study aimed to compare the illumination of the operational field with a 3D system and a standard microscope eyepiece during cataract surgery. SUBJECT AND METHODS: We retrospectively evaluated 91 eyes of 84 consecutive patients who were undergoing cataract surgery at our hospital. We used the 3D system and the eyepiece on alternative days. We determined the minimum light intensity required for safe surgery using the foot switch of the microscope (OMS800; Topcon, Tokyo, Japan). Illuminance on the ocular surface and the minimum illuminance required for the operation were calculated from the minimum light intensity. RESULTS: The 3D system was used in 45 eyes (3D group), and the eyepiece was used in 46 eyes (eyepiece group). The values of minimum illuminance in the 3D group were significantly lower than those in the eyepiece group (3D: 5500 ± 2000 lux, eyepiece: 11,900 ± 1800 lux; p < 0.001*). In addition, the illuminance of the operational field was reduced by 60.4% on average using the 3D system. CONCLUSION: With real-time digital processing and automated brightness control, the 3D system reduced ocular surface illumination by 50% or more. Hence, the 3D system may contribute to reducing the risk of retinal phototoxicity and patient photophobia.

＜文献概要＞目的:網膜剥離を合併した朝顔症候群の治療法は確立していない。筆者らは,片眼性または両眼性の本症3例4眼の病状と治療経過,転帰について今後の治療法選択の一助となるよう報告する。症例:症例1は14歳の女児(片眼性),症例2は43歳の女性(片眼性),症例3は20歳の男性(両眼性)で,症例3の左眼は前医で治療された後に眼球癆となった。所見:症例1の矯正視力は,右1.0,左0.01で,左眼に朝顔症候群と黄斑を含まない乳頭周囲に限局した網膜剥離を認めた。網膜裂孔は同定されなかったため,経過観察を行い,初診から5年後に網膜は自然復位した。最終受診時視力は眼前30cm手動弁だった。症例2の矯正視力は右光覚弁,左1.0で右眼に朝顔症候群と網膜が全剥離した増殖硝子体網膜症を認めた。硝子体手術中に見つかった耳側の網膜裂孔に対して液空気置換後に網膜光凝固を行いシリコーンオイルを留置した。網膜は復位したが,術後5ヵ月で視力0となった。症例3の矯正視力は右0.03,左0で右眼に朝顔症候群と耳側の網膜裂孔による網膜剥離を認めた。強膜内陥術が施行され,網膜は復位した。最終受診時視力は右0.03であった。結論:筆者らの経験した本症4眼中3眼は,経過観察や手術で網膜が復位した。原因裂孔が見つからない場合の手術選択は,自然復位の可能性もあるため,剥離範囲の拡大の有無や,片眼性か両眼性か,他眼の視力などを考慮しながら慎重に行うのがよいと思われる。