無硝子体眼の白内障手術

Cataract surgery in avitreous eyes

　無硝子体眼24眼の白内障手術に際し，術中術後の合併症を検討し，その特徴および対策につき考按した．非シリコン充填眼では，水晶体嚢内摘出術（ICCE）と水晶体嚢外摘出術（ECCE）は，それぞれの特徴を理解して行えば，どちらの術式をとっても良いと考えられた．シリコン充填眼では，術中のシリコンの眼外脱失や術後の前房内への嵌入を防ぐためには，ECCEの方が術式としては適当であると考えられた．シリコン充填眼に対しては，ICCEでもECCEでも必ず下方6時の位置に周辺虹彩切除を施行しておく必要があり，シリコン充填眼でしかも糖尿病眼では術後虹彩切除部位が詰まりやすく，その対策として下方の虹彩切除は大きめにする必要があると考えられた．

We evaluated a series of 24 eyes that underwent cataract surgery during the foregoing 4 years through 1960. All the eyes had been treated by prior vitrectomy for complications of diabetic retinopa-thy, retinal detachment, or branch retinal vein occlusion. Additional intravitreal silicone implant had been performed in 10 eyes. we employed intracapsular cataract extraction (ICCE) in 11 eyes, and extracapsular cataract extraction (ECCE) in13eyes. Based on our observations, we propose the following guidelines in planning cataract surgery in avitreous eyes.

For eyes without intravitreal silicone, one may employ either ICCE or ECCE. ECCE is the method of choice for eyes with intravitreal silicone, because one can thus avoid herniation of silicone oil into the anterior chamber and the loss of silicone oil. Peripheral iridectomy at the 6 o'clock position is advocated for eyes with intravitreal silicone. As the created iris hole is liable to fibrinous clogging in diabetic eyes,a larger peripheral iridectomy is pref-erable than is customary for non-diabetic eyes.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41 (7) : 863-866,1987