前囊収縮による眼内レンズ偏位の1例—免疫組織化学的検討

A case of intraocular lens dislocation with anterior capsule contraction.

要約　目的：急性隅角閉塞症の既往眼に対する超音波水晶体乳化吸引術（PEA）＋眼内レンズ（IOL）挿入後，前囊収縮によるIOL偏位の1例を報告する。

症例：急性隅角閉塞症後PEA＋IOLを受けた64歳の女性が，術1か月後前囊収縮に伴いねじれたように変形したIOL偏位がみられ，術4か月後IOL摘出＋IOL強膜内固定を受けた。摘出した前囊下の組織には免疫組織学的に筋線維芽細胞が検出された。最終矯正視力は角膜浮腫のため左（0.5）であった。

結論：狭隅角眼などZinn小帯脆弱が疑われる症例での白内障手術では水晶体囊の収縮が生じやすく，IOLの材質の選択や水晶体囊拡張リングの使用について考慮すべきである。

Abstract　Purpose: To report a case of intraocular lens dislocation with anterior capsule contraction.

Cases: A 64-year-old woman received laser iridotomy for acute closed-angle glaucoma in the left eye. She received cataract surgery 3 months later with phacoemulsification-aspiration and intraocular lens（IOL）implantation. The eye showed IOL dislocation with torsional deformation of the haptic one month later. The eye was treated by IOL extraction followed by scleral fixation of another IOL 4 months later. The removed specimen showed presence of myofibroblasts in the subcapsular tissue by immunohistological studies. The final visual acuity was 0.5 due to corneal edema.

Conclusion: Zonular instability following acute closed-angle glaucoma may have resulted in IOL dislocation. Acrylic single-piece IOL is to be avoided due to eventual torsional deformation of the haptic. Use of capsular ring is expected to reduce the risk of IOL dislocation.