乳児の急性硬膜下血腫に続発し増殖性変化を来した両眼硝子体出血の1例

Bilateral vitreous hemorrhage following subdural hematoma in an infant

　急性硬膜下血腫に引き続き，両眼に著明な硝子体出血を起こした生後9カ月の男児の症例を経験した．

　左眼には，繊維性増殖膜が形成され続発性網膜剥離が起こったため，硝子体手術等を施行したが最終的には眼球癆となった．右眼は保存的に経過観察を行ったが，視機能の保持は不可能であった．

　この症例の発症および経過に関して，以下のように推測した．急性硬膜下血腫に続いて起こった硝子体出血は，突然の頭蓋内圧上昇により，中心性網膜静脈閉塞症と類似する状況が起こったためである．また，新生血管を伴った増殖性変化は，静脈閉塞が硬膜下水腫のため遷延したため，反応性に起こったものである．

A 9-month-old male infant developed acute subdural hematoma induced by blunt head trauma. Immediate craniotomy was performed followed by creation of a subdural -peritoneal shunt 4 weeks later. We detected bilateral, diffuse preretinal hemorrhage 23 days after the trauma. The hemorrhage gradually exacerbated and resulted in fibrovascular membrane formation with tractional retinal detachment in the left eye.

The left eye was treated by lensectomy, vitrectomy, membrane-peeling and fluid-air exchange procedures 13 weeks after the initial trauma. After an initialimprovement in retinal detachment, hyphema and vitre-ous hemorrhage developed 3 weeks later to eventually result in phthisis bulbi.Vitreous hemorrhage increased in the right eye to induce near-blindness 14 weeks after the trauma.

Circumstantial evidences indicated that the vitreous hemorrhage was the result of a sudden increase in intracranial pressure after subdural hematoma. A resultant obstruction of the central retinal vein would have contributed to the formation of fibrovascular membrane in the vitreous.

Rinsho Ganka (Jpn J Clin Ophthalmol) 40(1) : 53-56, 1986