水晶体位置異常に対する手術成績

Surgical management of dislocated crystalline lenses

　水晶体位置異常に対して輪部強角膜切開創から水晶体摘出術を行った24例28眼について検討した。外傷性が10例10眼，特発性が11例13眼，マルファン症候群が2例4眼，無虹彩症が1例1眼であり，硝子体内脱臼が7眼，硝子体内亜脱臼が17眼，前房内脱臼が3眼，前房内亜脱臼が1眼であった。術後，73.1％で視力が改善し，術前に緑内障を合併した16眼の75％で眼圧がコントロールされた。網膜剥離が術前に1眼にみられ，術後，5眼に起こった。強角膜切開で水晶体摘出術を行う方針であれば，水晶体位置異常による重篤な合併症がない症例は手術適応としないほうがよいと思われる。

We treated 28 eyes with dislocated lenses. Dis-location was due to trauma 10 eyes, Marfan syn-drome 4 eyes, aniridia 1 eye and was idiopathic in 13 eyes. The lens was dislocated into the vitreous 7 eyes, subluxated in the vitreous 17 eyes, dislocated into the anterior chamber 3 eyes and subluxated in the anterior chamber 1 eye. In the majority of eyes, we removed the dislocated lens through corneo-scleral incision followed by anterior vitrectomy whenever feasible.

After surgery, the visual acuity improved in 19 eyes, 73%. The intraocular pressure was controlled in 12 of 16 eyes with previous glaucoma, 75%. Retinal detachment was initially present in 1 eye. It developed after surgical removal of dislocated lens in 4 of 24 eyes, 17%, without previous retinal detachment. It developed in 1 of 3 eyes, 33%, with history of retinal detachment. Removal of dislocat-ed lens through corneoscleral incision seemed to be contraindicated for benign or clinically silent cases.