空気灌流下硝子体手術に続発した駆逐性出血の3例

Three cases of massive choroidal hemorrhage after vitreous surgery under air insufflation

　空気灌流下硝子体手術に続発した駆逐性出血の3例を報告した．第1例は増殖性硝子体網膜症-D3の患者で，硝子体手術後に輪状締結術を施行中に駆逐性出血が発生した．第2，第3例は共に増殖性糖尿病性網膜症による黄斑部牽引性網膜剥離の症例で，硝子体手術と眼内液空気同時置換術を行った．第2例は翌日回診後，第3例は翌日深夜に眼圧が急激に上昇して硝子体出血を来した．再手術で駆逐性出血と確認され，第2例にはシリコンオイル注入を行った．現在，全例眼球癆となっている．空気灌流下硝子体手術に続発した駆逐性出血は，いずれも硝子体手術中には発生せず，灌流口抜去後または翌日に起こった．誘因としては，低眼圧，輪状締結術や歩行・診察が考えられ，しかも気体は液体に比して容積変化に対する許容性が高いため，ガスタンポナーデ中は脈絡膜出血が駆逐性出血に至りやすいと推論した．空気灌流下硝子体手術では，強膜創の縫合を強固にし，灌流口抜去は結膜縫合を除くすべての手術操作が終了してから行う必要があると考えられた．

We report three cases of massive choroidal hem-orrhage during or following vitreous surgery under air insufflation.

A 59-year-old female manifested retinal detach-ment with advanced proliferative vitreoretinopathy (PVR D3). Expulsive choroidal hemorrhage occur-red during scleral encircling procedure following intraocular manipulations by vitrectomy and airinsufflation. The other 2 cases, a 59-year-old female and a 31-year-old male, presented with proliferative diabetic retinopathy with tractional retinal detachment in the macula. Both cases were treated by vitrectomy followed by intraocular air insufflation and scleral encircling procedure. Mas-sive choroidal hemorrhage occurred on the next day after surgery in both cases.

Intraocular air tamponade appears to be more prone to allow choroidal hemorrhage into expulsive hemorrhage because air is much more compressible and therefore exerts less resistance to expansion of hemorrhage than fluid.

Rinsho Ganka (Jpn J Olin Ophthalmol) 41(3) : 255-258, 1987