Japanese
English
- 有料閲覧
- Abstract 文献概要
- 1ページ目 Look Inside
- 参考文献 Reference
要約 目的:抗血管内皮増殖因子(VEGF)薬硝子体注射後に後囊破損および外傷性白内障を生じ,水晶体再建術を行った5例を経験したので報告する。
対象と方法:2015〜2019年の間に佐賀大学医学部附属病院眼科にて,抗VEGF薬硝子体注射後の外傷性白内障に対し水晶体再建術を施行した5例を後ろ向きに調査した。
結果:術前に明らかな後囊破損が確認できたのは3例で,他は術中に確認された。成熟白内障の1例は,hydrodissection直後に核落下を生じた。Hydrodissectionを省略した3例において核落下を生じた症例はなかった。核落下を認めた1例と前房への硝子体脱出を認めた2例は硝子体手術を併施した。術後は,硝子体手術を併施した3例のうち1例で増殖硝子体網膜症を生じ,2例は抗VEGF薬硝子体注射への反応が不良となり光線力学療法やトリアムシノロンアセトニド(TA)テノン囊下注射を併用した。硝子体手術を併施しなかった2例では,抗VEGF薬硝子体注射やTAテノン囊下注射を継続した。
結論:硝子体注射後の破囊例でも術中操作に留意すれば硝子体手術を併用せずに水晶体再建術が可能である。硝子体手術を併用した場合,術後経過やその後の原疾患の経過にも影響することがあり,可能な限り水晶体再建術のみで終了することが望ましい。
Abstract Purpose:We report the experience of five cases of lens reconstruction for traumatic cataract after intravitreal injection of anti-vascular endothelial growth factor(VEGF)agents.
Cases:Five cases of traumatic cataract and posterior capsule rupture caused by intravitreal injection of anti-VEGF agents, from 2015 to 2019, at Saga University Ophthalmology Department.
Results:Posterior capsule rupture was evident preoperatively in three cases, and was confirmed intraoperatively in the remaining two. In one case of mature cataract, the lens nucleus was dislocated after hydrodissection, and in the three cases in which hydrodissection was not performed, lens nucleus dislocation was not observed. In the case of lens nucleus dislocation and in two cases of vitreous prolapse into the anterior chamber, simultaneous vitrectomy was performed. Postoperatively, one of three patients who underwent anterior vitrectomy developed proliferative vitreoretinopathy. Two patients had a poor response to intravitreal injection of anti-VEGF agents, which was combined with photodynamic therapy and subtenon injection of triamcinolone acetonide(TA). For the two patients who did not undergo vitrectomy, intravitreal injection of anti-VEGF agents or subtenon injection of TA was continued.
Conclusion:Lens reconstruction without vitrectomy is possible in cases of posterior capsule rupture after vitreous injection with careful intraoperative attention. Vitrectomy may affect the postoperative course and subsequent course of the primary disease, and it is advisable to end the procedure with lens reconstruction alone, whenever possible.
Copyright © 2021, Igaku-Shoin Ltd. All rights reserved.