治療を要した小切開水晶体乳化吸引術後のデスメ膜剝離

Detachment of Descemet membrane following small-incision phacoemulsification and aspiration

要約　目的：白内障術後のデスメ膜剝離に対し治療を行った6例の臨床経過を報告する。

対象と方法：デスメ膜剝離に対し，既往歴，発生時期，剝離範囲，治療，術後最高視力，術後角膜内皮細胞密度減少率について検討した。

結果：デスメ膜剝離の発生時期は核乳化吸引時1眼，皮質吸引時1眼，hydration時3眼で，残りの2眼では発生時期は不明であった。他院より紹介となった症例はPEA後5日目に治療を行ったが，他の6眼では手術終了時に初回治療が行われ，全例で前房内空気注入が行われた。術前平均視力は0.6，術後平均視力は0.9であった。平均角膜内皮減少率は42.4％であったが，最大で74.5％減少した症例もあった。

結論：早期にデスメ膜剝離を発見し，前房内空気置換にてデスメ膜の復位を得ることが予後に重要と思われた。

Abstract　Purpose：To report 6 cases who were treated for detachment of Descemet membrane following cataract surgery.

Cases and Method：This retrospective study was made on 7 eyes of 6 cases with detachment of Descemet membrane following phacoemulsification and aspiration in the past 14 years. They were evaluated regarding past history, time of occurrence during surgery, extent of detachment, method of treatment, visual outcome, and changes in corneal endothelial cells.

Results：Detachment of Descemet membrane occurred during aspiration of lens nucleus in one eye, during aspiration of lens cortex in one, during hydration in 3 eyes, and unknown in 2. Six eyes were treated by exchange of aqueous humor by air immediately after cataract surgery. One eye received the same treatment 5 days after cataract surgery. Visual acuity averaged 0.6 before surgery and 0.9 after treatment. Corneal endothelial cells decreased by an average of 42.4％. One case showed decrease by 74.5％.

Conclusion：Early diagnosis with prompt treatment seemed to be essential for the outcome of detachment of Descemet membrane during cataract surgery.