超音波水晶体乳化吸引術と眼内レンズ移植術後に両眼に発症した前部虚血性視神経症

A case of bilateral anterior ischemic optic neuropathy after cataract surgery

　両眼の眼内レンズ移植術後に，両眼それぞれに前部虚血性視神経症（以下AION）を発症した82歳の男性の1例を報告した。右眼は超音波水晶体乳化吸引術と後房レンズ移植術（以下PEA＋IOL）をうけ，術後1年1か月目にAIONが発症した。左眼は，右眼の手術の5か月後にPEA＋IOLをうけたが，術中硝子体脱出があり，術後眼圧が上昇した。術後20日目にAIONと思われる視神経乳頭浮腫を認めた。全身的には高血圧症，多発性脳梗塞を認めた。右眼のAIONの発症には眼圧上昇が関与していると考えられた。眼内レンズ手術後のAIONは，わが国では稀であるが，重篤な術後合併症のひとつとして，常に念頭におくべきである。

An 82-year-old man underwent phacoemulsifica-tion and aspiration (PEA) surgery in his left eye, which resulted in posterior lens capsule rupture and vitreous loss. A posterior chamber intraocular lens (pc-IOL) was sutured to the ciliary sulcus. Corneal edema resulting from endothelial dysfunction and elevated intraocular pressure during the postoper-ative period decreased 20 days after surgery, which visualized the swelling and flame-shaped hemor-rhages in the left optic disc consistent with anterior ischemic optic neuropathy (AION). Visual acuity was 0.03 and hardly recovered.

The patient complained of sudden painless visual loss in the right eye 8 months after the onset of AION in the left eye and 13 months after theuneventful PEA and pc-IOL implantation surgery in his right eye. Fundus examination revealed pseudo Foster-Kennedy syndrome with the right optic disc swelling and the left optic disc atrophy. Despite systemic corticosteroid administration his right vision decreased to light sense and never recovered. Painless visual loss, hypertension, nega-tive MRI study except for multiple tiny cerebral infarctions, absence of temporal arterial swelling and tenderness and erythrocyte sedimentation rate of 47mm/h led us to diagnose non-arteritic AION in both eyes. Postoperative elevation of IOP was suspected to be involved with the occurrence of AION in the left eye, while the mechanism of AION in the right eye remained to be proved.