強膜内陥術後に特異な前眼部炎症を呈したアトピー性網膜剝離の1例

A case of atopic retinal detachment with unusual ocular surface inflammation after scleral buckling

要約　背景：アトピー性皮膚炎（AD）患者では，皮膚だけでなくアトピー眼症と呼ばれる種々の眼疾患を併発する。

症例：症例は19歳の男性で，幼少期よりADの既往歴がある。右眼に網膜剝離を認め，強膜内陥術を施行した。術翌日より結膜充血，浮腫，眼瞼腫脹の増悪を認めた。何らかのアレルギーと考えベタメタゾンおよびモキシフロキサシン点眼を開始，術後6日よりタクロリムス点眼を追加し経過をみていたが改善せず，術後10日に余剰結膜の切除を施行した。術後12日にさらに眼脂・充血が増悪し，シリコーンスポンジに対するアレルギーあるいは感染を疑い，同日右眼シリコーンスポンジ摘出を施行した。シリコーンスポンジを縫着していた位置の強膜は菲薄化しており，周囲のテノン囊および結膜下組織の著しい増生を認めた。眼脂およびシリコーンスポンジ培養のいずれもメチシリン耐性黄色ブドウ球菌が検出された。術翌日よりメチルプレドニゾロン250mg点滴を3日間追加し，結膜充血，眼瞼腫脹は急速に改善を認めた。

結論：網膜剝離に対する強膜内陥術後翌日より強い前眼部炎症をきたし，シリコーンスポンジの除去により改善したAD患者の1例を報告した。感染の影響は否定できないが，膿瘍などの強い感染所見はなく，強膜内陥術に使用したシリコーンスポンジあるいは縫合糸に対するアレルギー反応が主な病態であると考えられた。強膜内陥術後の遷延する充血や眼瞼腫脹はアレルギーの可能性も留意するべきと考えられた。

Abstract　Background：Patients with atopic dermatitis（AD）often develop various ocular diseases known as atopic eye disease, affecting not only the skin but also the eyes.

Case：The patient was a 19-year-old male with a history of AD since childhood. He presented with retinal detachment in his right eye and underwent scleral buckling surgery. On the day after the surgery, he experienced worsening conjunctival hyperemia, edema, and eyelid swelling. Although eye drops were increased on the 6th postoperative day, there was no improvement, and excision of excess conjunctiva was performed on the 10th postoperative day. On the 12th postoperative day, eye discharge and hyperemia further worsened. Suspecting an allergy or infection related to the silicone sponge, the silicone sponge was removed from the right eye on the same day. The sclera at the location where the silicone sponge was sutured was thinned, and significant proliferation of the surrounding Tenon's and subconjunctival tissues was observed. MRSA was detected in both the eye discharge and the silicone sponge cultures. Methylprednisolone 250 mg infusion was added for 3 days from the day after the surgery, resulting in a rapid improvement in conjunctival hyperemia and eyelid swelling.

Conclusions：We report a case of an AD patient who developed severe anterior segment inflammation the day after scleral buckling surgery for retinal detachment, which improved after removal of the silicone sponge. While the impact of infection cannot be ruled out, there were no strong signs of infection such as abscess formation. Therefore, the primary pathology was considered to be an allergic reaction to the scleral buckling silicone sponge or sutures. It is important to consider the possibility of allergy in cases of persistent hyperemia and eyelid swelling after scleral buckling surgery.