硝子体注射後の水晶体後囊破損に対する硝子体手術併用水晶体再建術を施行した1例

Ruptured posterior capsule after intravitreal injection treated by vitreous surgery and lens reconstruction

要約　目的：硝子体内注射後に後囊が大きく破損し，硝子体手術と水晶体再建術を行った症例の報告。症例：78歳女性の左眼に生じた加齢黄斑変性に対し，6年前から光線力学的療法，ベバシズマブの硝子体注射，ラニビズマブの硝子体注射が行われ，最近アフリベルセプトの硝子体注射が行われた。その翌日に視力が0.15に低下し，水晶体損傷が発見された。後囊下白内障と後囊破損があり，硝子体手術と水晶体再建術が実施された。連続円形前囊切開ののち，硝子体腔への灌流で後房圧を維持した。超音波乳化吸引術中に核落下はなかった。核周辺の物質が一部落下したが，硝子体切除の際に吸引除去できた。眼内レンズは囊外に固定した。術後0.2の視力が得られ，加齢黄斑変性の進行悪化はなく，10か月後の現在まで経過は良好である。結論：アフリベルセプトの硝子体注射後に生じた後囊破損に対し，後房圧の維持と慎重な術中操作で良好な結果が得られた。

Abstract.　Purpose：To report a case of ruptured posterior capsule following intravitreal injection treated by vitreous surgery and lens reconstruction. Case：A 78-year-old female had been diagnosed with age-related macular degeneration（AMD）in the left eye 6 years before. The affected eye received photodynamic therapy and vitreal injection of bevacizumab. After a recent session of intravitreal injection of aflibercept, visual acuity decreased to 0.15 due to damaged lens. The left eye showed subcortical cataract and ruptured posterior capsule. Vitreous surgery with lens reconstruction was performed the following day. After continuous curvilinear capsulorrhexis, the posterior chamber pressure was maintained by irrigation of the vitreous. Intravitreally displaced epinuculear material was removed by aspiration. The intraocular lens was extracapsularly fixated. The left eye gained visual acuity of 0.2. There has been no progression of AMD for 10 months until present. Conclusion：Ruptured posterior capsule was successfully treated by vitreous surgery and lens reconstruction under maintenance of posterior chamber pressure.