落下眼内レンズの水晶体囊を用いて意図的網膜裂孔の閉鎖を行った網膜剝離の1例

Intentional retinal tear closure for retinal detachment using the lens capsule of dropped intraocular lens

要約　目的：網膜下索状物を伴う網膜剝離（RD）に対する硝子体手術では，意図的網膜裂孔を作製することが索状物摘出に有用であるが，RD再発や増殖性変化の原因となりうる。落下眼内レンズ（IOL）の水晶体囊を用いて意図的網膜裂孔を閉鎖し，良好な結果を得られたRDの1例を報告する。

症例：72歳，女性。右眼は18歳時に外傷により失明。左眼は30年以上前にRDに対し輪状締結術，22年前に白内障に対して超音波乳化吸引術とIOL挿入術を施行した。1年以上前から左眼視力低下と飛蚊症の悪化があり，近医で左RDの診断となり，当院を紹介され受診した。初診時視力は右（光覚なし），左（0.1）で，左眼のIOL振盪を認めた。鼻側から下方にかけて網膜下索状物を伴う原因裂孔不明のRDを認め，25G硝子体手術を行った。手術開始後，IOLが眼内に落下したため摘出し，水晶体囊を眼外に保管した。意図的網膜裂孔を作製し，網膜下索状物を除去した。その後，水晶体囊を眼内に持ち込み網膜上に留置し，保管した。IOL強膜内固定を行った後，液空気置換を行い，輪状締結部辺縁および意図的網膜裂孔辺縁に網膜光凝固を施行した。空気置換下で水晶体囊を移動させ，意図的網膜裂孔を閉鎖した。眼内を20％ SF₆ガスで置換し，腹臥位とした。網膜復位は得られ，光干渉断層計では水晶体囊により意図的網膜裂孔が良好に閉鎖されていることが確認された。

結論：落下IOLの水晶体囊は網膜裂孔の閉鎖に使用できた。

Abstract　Purpose：In vitreous surgery for retinal detachment（RD）with subretinal strand（SS）, intentional retinal tear is useful for the SS extraction, however, can cause RD recurrence and proliferative vitreoretinopathy. We report a case of RD in which the intentional retinal tear was closed by using the lens capsule of dropped intraocular lens（IOL）with good results.

Case：A 72-year-old woman whose right eye was blind due to trauma at the age of 18. Her left eye underwent encircling scleral buckle for RD more than 30 years ago and phacoemulsification and IOL implantation for cataract 22 years ago. Since more than 1 year ago, the patient had decreased vision and worsened floaters in the left eye. The patient was diagnosed with left RD at a nearby hospital and referred to our hospital. Visual acuity at the initial visit was no light perception in the right eye and 0.1 in the left, and subluxated IOL was noted in the left eye. RD of unknown origin with the SS was recognized from the nasal side to the inferior retina, and 25-gauge vitrectomy was carried out. After the start of surgery, the IOL fell into the vitreous cavity and was removed, and the lens capsule was stored extraocularly. An intentional retinal tear was created, and SSs were removed. The lens capsule was brought into the eye and placed on the retina and stored. IOL scleral fixation was performed, followed by fluid-air exchange, and retinal photocoagulation was performed at the margin of the scleral buckle and the intentional retinal tear. The lens capsule was moved to the intentional retinal tear under the air, and it was closed. We conducted 20％ SF₆ tamponade, and the patient stayed in the prone position. The retinal attachment was obtained, and optical coherence tomography confirmed that the intentional tear was well closed by the lens capsule.

Conclusion：The lens capsule of the dropped IOL could be used for retinal tear closure.