眼内レンズ摘出術後に再発した黄斑円孔網膜剝離の1例

A case of retinal redetachment with macular hole following intraocular lens extraction

要約　目的：11年前に手術で復位した黄斑円孔網膜剝離が，眼内レンズ（IOL）摘出後に再発した症例の報告。症例：80歳女性が10日前からの右眼視力低下で受診した。11年前に右眼の黄斑円孔網膜剝離に対し硝子体手術，白内障手術，IOL挿入が行われていた。所見：矯正視力は右0.05，左0.5で，眼軸長は右29.10mm，左26.36mmであった。右眼ではIOLが下方に亜脱臼し，黄斑円孔は閉鎖していた。右眼のIOLを摘出し，その10日後に黄斑円孔網膜剝離が再発した。硝子体手術とシリコーンオイル挿入術を行ったが，網膜剝離は復位しなかった。結論：本症例で網膜剝離が再発した原因として，IOL摘出術中の眼圧変動と強度近視に特有な眼球剛性の脆弱性が推定される。

Abstract.　Purpose：To report a case who had received successful surgery for macular hole detachment in the past and who developed retinal redetachment following removal of subluxated intraocular lens（IOL）. Case：An 80-year-old woman presented with impaired vision in her right eye since 10 days before. The right eye had received vitreous surgery,lens extraction,and IOL implantation 11 years before. Findings：Corrected visual acuity was 0.05 right and 0.5 left. The ocular axis measured 29.10 mm right and 26.36 mm left. The right eye showed subluxation of IOL inferiorly. Macular hole appeared to be closed with no retinal detachment. Retinal detachment with reopened macular hole recurred 10 days after removal of subluxated IOL. Vitreous surgery with silicone oil tamponade failed to induce reattachment of the retina. Conclusion：Retinal redetachment appears to have been induced by changes in intraocular pressure during IOL removal and by fragile sclera peculiar to high myopia.