後房レンズ挿入術後のフィブリン析出について その1 計画的嚢外法との比較

Fibrin exudate following posterior chamber lens implantation.:1. Comparison with planned extracapsular cataract extraction

　同一メーカー社製後房レンズ挿入術（PC-IOL）症例154眼を対象として，術後フィブリン析出の臨床像につき，計画的嚢外摘出術単独（P-ECCE）例34眼を対照として検討した．フィブリンは，形態によりO：フィブリン（-），I：線状フィブリン，IIa：膜状フィブリンでIOL光学部の透見可能，IIb：膜状フィブリンでIOL光学部の透見不可能，III：塊状フィブリンとに分類され，さらにその発症時期により，早期発症型フィブリンと後期発症型フィブリンとに分類された．早期発症型フィブリンは，PECCE,PC-IOLの両群にみられ，その発症頻度は22眼14％，発症日は術翌日，平均持続期間は2.7日であった．原因としては手術侵襲，水晶体遺残物が考えられた．後期発症型フィブリンはPC-IOL群のみにみられ，その発症頻度は58眼38％，平均発症日は術後4.7日，平均持続期間は8.0日であり，その発症にはIOLによる起炎性反応が関与していると考えられた．

We studied postoperative fibrin exudation in cases of the posterior chamber lens (IOL) im-plantation comparing with simple extracapsular cataract extraction (ECCE). The subjects com-prised of 154 eyes undergoing ECCE with posterior chamber lens implantation and 34 eyes with ECCE alone which were performed by the same surgical procedure. We implanted IOLs provided by the same manufacturer. In this study, we classified fibrin exudate into 4 grades according to slit-lamp findings as follows : fibrillar filaments only as grade I , IOL-visible membranous fibrin exudate as grade II a, IOL-invisible thick membrane asgrade II b and massive exudate as grade III. We also identified two types of fibrin exudates in relation to the onset of the exudation. One was early-onset type and the other late onset type. The former appeared mainly in the first postoperative day and was observed in both groups regardless of the presence or absence of intraocular lens. It occurred in 22 eyes (14%) of the cases and lasted for a mean period of 2.7 days. The latter was observed in 58 cases (38%) with IOL implantation alone. The mean onset was 4.7 postoperative days and the mean duration was 8.0 days. We concluded that the early-onset fibrin exudation was non-specific but the late onset fibrin was specific for IOL implanta-tion and thought to be a kind of toxic lens reaction.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(12) : 1323-1328,1987