アトピー白内障の手術術式

Surgical technique for atopic cataract

　最近5年間に当科でアトピー白内障の手術を行った14例18眼を対象として，また過去の報告例277眼も加えアトピー白内障の手術術式を検討した。当科では嚢外摘出術で破嚢しなかったものは全例術後に網膜剥離をみなかったことから最近推奨されている水晶体全摘出術，前部硝子体切除術，輪状締結術が初回から必要とは思えない。ただし，破嚢やNd-YAGレーザー後嚢切開術で硝子体脱出を認めた例は後嚢と硝子体・毛様体・周辺部網膜の癒着，牽引，硝子体の前方移動により術後剥離が生じると考えられ，前部硝子体切除術や輪状締結術の併用が必要であろう。白内障術前に鋸状縁または毛様体裂孔に伴う網膜剥離のある例は水晶体全摘出術，硝子体切除術，輪状締結術が望ましいと思われる。

We reviewed surgically treated 18 eyes of atopic cataract in 14 patients over the past 5-year period. Retinal detachment was present in 6 eyes and absent in 12 eyes at the time of cataract surgery. In 6 eyes in the latter group, no case developed retinal detachment following extracapsular cataract extraction with intact posterior capsule. Eventual retinal detachment could be prevented in the other 3 eyes with ruptured posterior capsule either during surgery or after Nd-YAG laser capsulotomy by performing anterior vitrectomy and scleral encircling. Retinal detachment in 6 eyes, which was present at the time of cataract surgery, was due to tear in ora serrata or ciliary body. It was effectively treated by combined procedure of lesectomy, vitrectomy and scleral encircling.