血友病A患者にみられた鈍的眼外傷の1例

Blunt ocular trauma in a patient with hemophilia-A

要約　目的：鈍的外傷で生じた前房出血に対し血液凝固第Ⅷ因子製剤が奏効した血友病A患者の報告。症例：ソフトボールが左眼に当たり，その直後から眼痛と視力障害が生じ，その翌日受診した。左眼視力は手動弁で，眼圧は37mmHgであった。左眼角膜は浮腫状で，前房は出血で充満していた。血液凝固第Ⅷ因子が3％であり，正常値が80～140％であるのに対し著しく低かった。出血時間は2分30秒と正常であった。治療として血液凝固第Ⅷ因子製剤を点滴投与し，前房洗浄を行った。受傷の3週後から硝子体出血の減少がはじまり，視力は受傷5週後に0.02，9週後に1.5に改善した。結論：血友病A患者に生じた外傷性前房出血に対し，血液凝固第Ⅷ因子製剤を全身投与することで前房洗浄が可能になり，硝子体出血が自然寛解した。

Abstract.　Purpose：To report a patient with hemophilia-A who was treated by recombinant factor Ⅷ concentrate for trauma-induced hyphema. Case and Findings：A 18-year-old male was hit by a flying softball on his left eye. He noted pain and blurring of left vision. When seen the next day,his visual acuity was hand motion left with intraocular pressure（IOP）of 37mmHg. The left cornea was edematous. The anterior chamber was filled with blood. He was diagnosed with hemophilia A with factor Ⅷ level of 3％. His bleeding time was within normal limit. Irrigation of anterior was performed without incident after intravenous injection of recombinant factor Ⅷ concentrate. Vitreous hemorrhage started to be absorbed 3 weeks after the trauma. Visual acuity improved to 0.02 5 weeks and to 1.5 9 weeks after trauma. Conclusion：Systemic recombinant factor Ⅷ concentrate seemed to facilitate irrigation of anterior chamber and spontaneous absorption of vitreous hemorrhage in a patient with hemophilia-A.