偽水晶体眼における水晶体起因性ぶどう膜炎

Phacoanaphylactic uveitis following intraocular lens implantation

　人工水晶体移植眼に水晶体起因性ぶどう膜炎と考えられる3症例を経験した．1例は人工水晶体摘出および硝子体手術にてぶどう膜炎は改善したが，網膜剥離を併発した．他眼には水晶体全摘術および前房レンズ移植を行い良好な視力を得た．第2例は人工水晶体を水晶体嚢ごと摘出し，同時に前房レンズを再移植し良好な視力を得た．第3例は前房レンズが移植してあったため，硝子体切除器にて残留皮質を除去することにより治癒した．

　水晶体起因性ぶどう膜炎はステロイド等の薬物に反応せず，唯一の治療方法は残留皮質の摘出である．そして1眼に起きた場合，他眼の手術は全摘術にすべきである．

We observed three cases of presumed phacoana-phylactic uveitis following posterior chamber lens im-plantation surgery. The interval between cataract sur-gery and the onset of iritis was broadly variable : it occurred 2 days, 39 days and 20 days after intraocualar lens implantation.

We employed various therapeutic means in our cases with beneficial effects. The first case was treated by removal of the intraocular lens with simultaneous vitrectomy. The second case was treated by removal of the intraocular lens and the whole lens capsule with reimplantation of an anterior chamber lens. The third case was treated by removal of the residual lens cortex by pars plana approach.

Phacoanaphylactic uveitis is resistant to almost all forms of conventional therapy including topical or systemic corticosteroid. Its sole rational treatment lies in surgical removal of the residual lens cortex, and not the intraocular lens. Once this uveitis develops in one eye, the fellow eye has to be treated by intracapsular cataract extraction.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(2) : 113-118, 1987