外傷性水晶体脱臼手術の眼圧経過と視力予後

Intraocular pressure and visual outcome following surgery for traumatic lens dislocation

要約　目的：外傷性水晶体脱臼に対する手術後の眼圧と視力の経過の報告。対象と方法：2011年2月までの38か月間に，外傷性水晶体脱臼に対して，硝子体手術と水晶体切除を施行した9例9眼を対象とした。脱臼の原因は急性期6眼（作業中5眼，交通事故1眼）と慢性期3眼（ボクシング，アトピー，転倒各1眼）で，脱臼の状態は完全脱臼4眼と亜脱臼5眼で，両群に眼内レンズ脱臼が各1眼あった。結果：8～46か月（平均20か月）の経過観察で，全例に良好な最終視力を得た。3眼（33％）で手術前後を通じ高眼圧で，2眼（22％）は術後に低眼圧が生じ，これら5眼は隅角の損傷が90°以上の範囲にあり，虹彩離断または鋸状縁断裂があった。術後の眼圧管理にはピロカルピン点眼が有効なものもあった。虹彩離断に対しては，虹彩つきソフトコンタクトレンズ装用も有効であった。結論：外傷性水晶体脱臼では，術後の眼圧管理が重要である。

Abstract.　Purpose：To report the course of intraocular pressure（IOP）and visual acuity following surgery for traumatic lens dislocation. Cases：We reviewed 9 eyes of 9 cases who were treated for traumatic lens dislocation in the past 38 months. Lens dislocation occurred immediately after trauma in 6 eyes and gradually in 3 eyes. Four eyes had lens luxation and 5 eyes had subluxation. Both groups included one pseudophakic eye each. Results：After follow-up for 8 to 46 months,average 20 months,all the cases showed good final visual acuity. Ocular hypertension was present in 3 eyes（33％）before and after surgery. Ocular hypotony developed after surgery in 2 eyes（22％）. IOP control was needed in these 5 eyes that showed impaired chamber angle for one quarter or over and that showed dialysis of the iris or ora serrata. Instillation of pilocarpine was effective for some of occular hypertension. Use of soft contact lens with iris was effective for iridodialysis. Conclusion：Close attention to IOP is needed after surgery for traumatic lens dislocation.