眼内レンズ強膜内固定術後に創閉鎖不全と増殖硝子体網膜症をきたしたApert症候群の1例

A case of severe astigmatism, delayed postoperative wound closure, and postoperative vitreoretinopathy associated with Apert syndrome

要約　目的：眼内レンズ亜脱臼に対して強膜内固定術を行ったApert症候群の術後合併症について報告する。

症例：60代，男性。幼少期にApert症候群と診断されており，左白内障手術の既往があった。左眼内レンズ亜脱臼の手術目的に九州大学病院を紹介された。右−7.0D，左−12.5Dと両眼に強度の斜乱視を認めており，左眼の強主経線上に角膜切開で主創口を作製し，眼内レンズ強膜内固定術を行った。術後，角膜創の閉鎖不全による房水漏出を認めた。複数回の角膜縫合を行ったが，十分な創閉鎖が得られず，脈絡膜剝離および硝子体出血が出現したため，術後21日目に硝子体手術を施行した。強角膜縫合により創口閉鎖は得られたが，眼底には脈絡膜剝離に伴う網膜剝離を認め，硝子体切除および眼圧維持を目的にシリコーンオイル注入を行った。術後いったんは網膜復位を得られたものの，増殖性硝子体網膜症に至った。

結論：強度の斜乱視を伴うApert症候群の内眼術後に創閉鎖不全および増殖硝子体網膜症を合併した症例を経験した。

Abstract　Purpose：To report postoperative complications in a patient with Apert syndrome who underwent surgery for intraocular lens（IOL） dislocation.

Case：A 60-year-old male, diagnosed with Apert syndrome since childhood, was referred for surgery due to intraocular lens dislocation in his left eye. Both eyes exhibited severe astigmatism, with a cylindrical power of −7.0 and 12.5 diopters in the right and left eyes, respectively. The intrascleral fixation of the IOL was successfully performed. However, on postoperative day 1, aqueous humor leakage was observed from the corneal incision made to correct severe astigmatism. The leakage persisted despite multiple additional corneal wound sutures. As hypotony continued, choroidal detachment and vitreous hemorrhage occurred. Corneoscleral suturing and vitrectomy, followed by silicone oil injection, were performed on postoperative day 21. The patient underwent a second vitreoretinal surgery to treat subsequent proliferative vitreoretinopathy on postoperative day 50.

Conclusion：We experienced a case of Apert syndrome complicated by severe astigmatism, delayed corneal wound closure, and proliferative vitreoretinopathy following scleral fixation of the IOL.