外傷性散瞳症例への瞳孔形成術の成績

Outcome of pupilloplasty for traumatic mydriasis

要約　目的：鈍性外傷による散瞳に対し，虹彩牽引術を行った2症例の報告。症例：症例1は54歳男性で，飲酒時に右眼がドアノブに当たり，強膜破裂と硝子体出血が生じた。緊急手術後に麻痺性散瞳が生じた。瞳孔径は8mmであった。前房に挿入した硝子体攝子で瞳孔縁を把持し，瞳孔の中心に向けて牽引した。この操作を5か所で行い，瞳孔径は4mmになった。1年後の現在まで羞明などはない。症例2は41歳男性で，乗用車を運転中に追突され，エアバッグにより右眼を打撲した。他医により水晶体摘出と硝子体手術が行われた。麻痺性散瞳で3か月後に受診した。瞳孔径は9mmであった。症例1と同様な操作を8か所で行い，2か所での虹彩縫縮を追加した。瞳孔径は5mmになり，1年後の現在まで羞明はない。結論：外傷後の麻痺性散瞳に対し，器械的な虹彩牽引が奏効した。

Abstract.　Purpose：To report 2 cases who received pupilloplasty for traumatic paeralytic mydriasis. Cases：One case was a 54-year-old male who was hit by a door knob in the right eye. After treatment for scleral rupture and vitreous hemorrhage, he developed paralytic mydriasis with pupillary diameter of 8 mm. The condition was treated by gently pulling the iris margin with vitreous forceps at 5 sites. The pupillary diameter became 4 mm. There has been no photophobia for one year until present. The other case was a 41-year-old male. His right eye was injured by an airbag after collision while driving a car. Paralytic mydriasis developed after emergency surgery. The pupillary diameter was 9 mm when seen 3 months after the accident. The condition was treated by gently pulling the iris margin with vitreous forceps at 8 sites with additional iridodplasty by placing 2 sutures. The pupillary diameter became 4 mm. There has been no photophobia for one year until present. Conclusion：Mechanical iris pulling technique was effective for posttraumatic paralytic mydriasis.