谷川 篤宏

PURPOSE: Recurrent retinal detachment (re-RD) after rhegmatogenous retinal detachment (RRD) surgery is associated with poor visual outcomes. This retrospective study evaluated the incidence and risk factors for re-RD following primary 25-gauge pars plana primary vitrectomy (25G-PPV). STUDY DESIGN: Retrospective observational study METHODS: Consecutive patients who underwent initial 25G-PPV at Fujita Health University Hospital between January 2011 and March 2019 were included. After applying exclusion criteria, preoperative and surgical factors were obtained from medical records. Patients were categorized into re-RD and initial reattachment groups. Univariate analysis was used to identify factors associated with re-RD, followed by multivariate analysis of significant variables. RESULTS: Among 1399 eyes, the mean age was 56.5±11.0 years. The re-RD and reattachment groups included 89 and 1310 eyes, respectively. The initial reattachment rate was 93.2%. Significant differences were observed between macular detachment and inferior retinal break (RB). The odds ratios of macular detachment and inferior RB in the re-RD group were 1.70 (95% confidence interval [CI] 1.05-2.79) and 2.26 (1.40-3.61), respectively. CONCLUSION: The initial reattachment rate with 25G-PPV was 93.2%. The re-RD group showed higher rates of macular detachment and a higher proportion of inferior RB, identified as risk factors for re-RD. RD due to inferior RB with macular detachment may require vitrectomy combined with buckling.

BACKGROUND: "Nepic®" (Japan Tissue Engineering Co., Ltd., Gamagori, Japan) is an autologous cultivated limbal epithelial sheet, approved in 2020 in Japan for the reconstruction of the corneal surface in cases of limbal stem cell deficiency (LSCD). Because the surgical procedure known as cultivated limbal epithelial cell sheet transplantation (CLET) has only recently been introduced and the number of cases remains limited, accumulating clinical experience is essential to ensure the safety and success of this procedure. Herein, we report the clinical course of a patient with unilateral LSCD who underwent CLET for a corneal surface reconstruction using Nepic®. CASE PRESENTATION: A 50-year-old man sustained bilateral eye injuries from mortar during construction work. The patient's right cornea exhibited LSCD. Initial treatment involved a 360° limbal transplantation with an allo-corneal graft at a university hospital. However, graft rejection occurred, and the corneal surface was subsequently covered by conjunctival tissue within 2 months. Because the patient's left cornea and conjunctiva appeared healthy, we performed CLET with Nepic® 3 years after the limbal transplantation. CONCLUSIONS: When using Nepic®, it is essential to become accustomed to handling the cultivated epithelial sheet on the ring-shaped holder; however, cultivated corneal epithelium transplantation can also be performed without the carrier material, but rather as a sheet. Though the corneal surface appeared smooth and shiny at 7 months postoperatively, we seek to determine whether the epithelial cells on the patient's cornea are of corneal or conjunctival origin without resorting to invasive procedures, such as biopsy.