マイラゲル®の術中強膜穿孔に強膜短縮術が有効であった1症例

Scleral shortening was effective for intraoperative perforation of the sclera by MIRAgel®

要約　目的：網膜剝離に対して用いられたマイラゲル^®が結膜外に露出し，これを摘出する手術中に強膜が穿孔した症例に，後日行った強膜短縮術が奏効した報告。

症例：62歳の女性が24年前にマイラゲル^®を用いた網膜剝離手術を受け，3か月前からマイラゲル^®が結膜外に露出して紹介受診した。10年前に白内障手術を受けていた。

所見と経過：矯正視力は右0.02，左0.03で，左眼には約−16Dの近視があった。右眼の鼻側球結膜に，白色透明で膨化したマイラゲル^®が露出し，眼底にマイラゲル^®による隆起が全周にあった。マイラゲル^®の摘出中に強膜が穿孔したので，部分摘出のみで手術を終了した。低眼圧と脈絡膜剝離が生じたため，4週後に再手術を行った。残存したマイラゲル^®を摘出し，菲薄化した強膜の周囲をマットレス縫合し，強膜短縮術を行った。術後の合併症はなく，眼圧が正常化した。

結論：マイラゲル^®を摘出するときには，強膜穿孔の可能性があることと，強膜穿孔には強膜短縮術が有効であることを，本症例は示している。

Abstract　Purpose: To report a case who had received scleral encircling using MIRAgel^® for retinal detachment, who developed baring of buckling material, and who was treated by scleral shortening surgery.

Case: A 62-year-old female was referred to us for exposure of MIRAgel^® that had developed 3 months before. She had received scleral encircling for retinal detachment using MIRAgel^® 24 years before.

Findings and Clinical Course: Best-corrected visual acuity was 0.02 right and 0.03 left. The left eye had myopia of about-16 diopters. The right eye showed extrusion of buckling material nasal to the cornea. Funduscopy showed elevation in the whole circumference by the buckling material. The sclera perforated during surgical attempt to remove the buckling material. Surgery was discontinued after partial removal of buckling material. Surgery was performed 4 weeks later due to sustained low intraocular pressure and choroidal detachment. The remaining buckling material was totally removed and the sclera was repaired by mattress suture and scleral shortening. The patient has been doing well for one year until present without complications and with normal intraocular pressure.

Conclusion: The present case illustrates that scleral perforation may develop during attempted removal of MIRAgel^® and that scleral shortening may be effective for perforated sclera.