計画的嚢外法の術後に生じた脈絡膜剥離を主病変とする交感性眼炎の1例

Choroidal detachment masqueraded sympathetic ophthalmia in a case after planned extracapsular cataract extraction

　老人性白内障の手術後に生じた交感性眼炎と思われる1例を報告した．症例は59歳の男性，右眼老人性白内障に対する計画的嚢外摘出術の約2カ月後に，両眼に脈絡膜剥離を主病変とするぶどう膜炎を発症した．ステロイド剤の全身投与により炎症の消褪を見たが，右眼底は網膜色素の脱失による夕焼け状眼底を呈した．その後，左水晶体を嚢内摘出したが，眼底は右眼と同様の夕焼け状であった．本症例のHLAはA24,B51,B_w60,DR_w9であり，免疫学的反応を来しやすい体質に，嚢外法摘出時の虹彩脱出による虹彩色素の遊出と残留皮質が関与して，交感性眼炎が発症したものと考えられた．

A 59-year-old male underwent planned extracap-sular cataract extraction in his right eye. Choroidal detachment and severe iridocyclitis developed in both eye 2 months later, leading to the diagnosis of sympathetic ophthalmia.

The patient manifested no systemic abnormal-ities as hearing loss or stiff neck. The symptoms improved with systemic corticosteroids, leaving a 'sunset glow' fundus in both eyes due to marked depigmentation in the choroid. His HLA typing was A24, B51, B_w60 and DR_w9. His genetic factor seemed to have participated in the immunological reaction to the iris pigment and residual lens cortex in the eye, resulting in sympathetic ophthalmia.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(6) : 717-719, 1988