後房型有水晶体眼内レンズ（ICL）術後に神経障害性疼痛が疑われた1例

A case of neuropathic pain after implantable collamer lens surgery

要約　目的：後房型有水晶体眼内レンズ（ICL）術後に神経障害性疼痛が疑われた1例を報告する。

症例：40歳，男性。20歳時にLASIKを両眼に施行。近医でICL手術を1年前に行った。術後3か月の間に2回虹彩毛様体炎を発症し，ベタメタゾンリン酸エステルナトリウム点眼液とレボフロキサシン点眼液4回/日，両眼で治療を行った。虹彩炎が寛解しても左眼に眼痛，羞明感，眼乾燥感が出現した。ICLのリサイジングのため，2回ICLを交換する手術を施行したが症状が改善せず，東邦大学医療センター大森病院眼科を受診した。

　初診時にドライアイ，再診時にICLの虹彩刺激と診断し，レバミピド点眼液，ジクアホソルナトリウム点眼液，トロピカミド・フェニレフリン塩酸塩点眼液により治療を開始した。症状は緩和したが，疼痛が残存したためICLを他院で抜去した。ICL抜去後も一部点眼治療で緩和されない疼痛が残存し，神経障害性疼痛と診断し，プレガバリン内服で治療を開始した。これにより，残存していた疼痛は減少し，自制範囲内とすることに成功した。

結論：LASIKなどの角膜手術やICL手術を契機として，ドライアイ以外の疼痛原因となる神経障害性疼痛を発症している可能性がある。そのような事例では早急な原因検索と診断加療を行う必要がある。

Abstract　Purpose：We report a case of neuropathic pain after ICL（Implantable Collamer Lens）surgery.

Case：A 40-year-old male underwent LASIK（laser in situ keratomileusis）surgery for both eyes at the age 20 years. He also underwent an ICL surgery one year ago. During the first three months following the surgery, he developed iridociliary inflammation twice and was treated with betamethasone phosphate sodium ophthalmic solution and levofloxacin ophthalmic solution four times a day in both eyes. He underwent surgery to replace the ICL twice for resizing, but his symptoms did not improve and he was referred to our department. The patient was diagnosed with dry eyes at the time of the first visit and iris irritation from the ICL at the time of the second visit, and treatment was initiated with levamipide ophthalmic solution, diquafosol sodium ophthalmic solution, tropicamide, and phenylephrine hydrochloride ophthalmic solution. The symptoms were relieved, but the ICL was removed at another hospital because of residual pain. After removal of the ICL, residual pain remained, which was not relieved by eye drops, and the patient was diagnosed with neuropathic pain. Treatment with oral pregabalin was started, and the pain improved markedly. The medication was continued at a maintenance dose, and the pain became controllable by the patient.

Conclusion：After corneal surgeries such as LASIK and ICL surgeries, patients might develop neuropathic pain that causes pain other than dry eye-related pain. Prompt search for causes, diagnosis and treatment are necessary in such cases.