硝子体切除後の白内障手術45眼の検討

A review of cataract surgery in forty-five vitrectomized eyes

　1984年から1988年までの間に，硝子体手術既往眼の白内障手術を45眼に行った。ECCEを行ったものが10眼と，ICCEが35眼であった。ECCEを行った際に後房レンズを4眼に挿入した。ICCEの際に，網膜復位のためにシリコンオイルを注入したものが13眼あり，逆にシリコンオイルを除去したものが6眼あった。術中に破嚢が8眼，核落下が4眼に起こった。ECCEの場合の問題点は，切嚢に際し水晶体が動き易いこと，核娩出に際し核落下が起こり易いこと，皮質吸引に際し破嚢が起こり易いことであった。ICCEの場合は，冷凍ペンシルの使用が困難で，破嚢核落下が起こり易かった。この間題に対処するため，硝子体灌流装置を取り付けて，手術を行うと良いこと，また灌流装置により術中の合併症に速やかに対処出来るばかりか，同時に術前合併症としての網膜の問題にも対処出来ることを述べた。

We performed cataract surgery in 45 eyes with a history of vitrectomy. Extracapsular cataract extraction (ECCE) was performed in 10 eyes and intracapsular one (ICCE) in 35. During surgery, lens capsule ruptured in 8 eyes, nucleus fell into the vitreous in 4 and expulsive hemorrhage occurred in 1. During ECCE procedure, capsulotomy was diffi-cult because of mobile lens. Delivery of the nucleus in the absence of formed vitreous was also difficult. During ICCE procedure, the use of cryoforceps was difficult because of continued diffusion of liquified vitreous into the anterior chamber, often resulting in rupture of the capsule and fall of the nucleus.

In order to cope with these problems, we are now using a vitreous infusion system, as elevation of the vitreous pressure allows a safe capsulotomy and nucleus delivery. Aspiration of the lens cortex and insertion of intraocular lens becomes safer when the lower vitreous pressure is well maintained. In ICCE procedure, lens delivery is facilitated by elevating the hydrostatic pressure in the vitreous. A fallen nucleus into the vitreous can be removed through a sclerocorneal incision. Preexisting retinal detachment can be fixed via transvitreal approach. Silicone oil can be removed or injected while the vitreous infusion system is attached. The outcome of cataract surgery in vitrectomized eyes can be improved by the use of the infusion system. The system also minimizes operative complications and allows immediate management should one occur.