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目的:人工的無水晶体・無硝子体眼に線維柱帯切除術を行い,遅発性脈絡膜出血が生じた症例の報告。症例:81歳男性が29年前に白内障手術を両眼に受け無水晶体眼になっていた。矯正視力は右手動弁,左1.5,右眼瞳孔縁に偽落屑物質,左眼に硝子体の前房内脱出があった。その4年後に左眼眼圧が上昇した。前部硝子体切除術を行い,1か月後にマイトマイシンC併用線維柱切除術を行った。翌日から脈絡膜全剝離が生じ視力が無光覚,眼圧が40mmHgになった。遅発性脈絡膜出血と診断し,手術11日目に経強膜的に脈絡膜出血を除去した。以後脈絡膜剝離は減少,軽快し,最終的に眼圧は12mmHgになり矯正視力は1.0になった。結論:脈絡膜出血の危険が高い症例への緑内障手術では,術中・術後の低眼圧に注意し,強膜弁を強めに縫合するなどの対策が望ましい。
Purpose:To report a case of delayed choroidal hemorrhage following trabeculectomy. Case:A 81-year-old male had received bilateral cataract extraction 29 years before. The left eye showed vitreous prolapse into the anterior chamber. Intraocular pressure(IOP)in the left eye rose to 39mmHg 4 years later. The eye received anterior vitrectomy and,one month later,mitomycin-C assisted trabeculectomy. Total choroidal detachment developed the following day with elevated IOP. The condition was diagnosis with delayed choroidal hemorrhage. Transscleral aspiration of choroidal hemorrhage was followed by flattening of the fundus,normal IOP,and visual acuity of 1.0. Conclusion:This case illustrates that choroidal hemorrhage may develop in a high-risk eye. Measures are needed to prevent hypotony during and after surgery.
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