アトピー性皮膚炎に伴う眼疾患の手術成績の検討

Surgical outcome for eye complications of atopic dermatitis

　過去5年間に東北大学医学部附属病院眼科において手術を行ったアトピー性皮膚炎に伴う白内障と網膜剥離の症例14例21眼について検討した。白内障手術のみ行った10眼中2眼で術中または術後に網膜剥離がみつかったが，バックリング手術を行い経過良好であった。またアトピー性皮膚炎に伴う網膜剥離の特徴とされる上耳側の硝子体基底部裂孔が全体の50％を占めていた。術後視力予後不良例は患者が白内障による視力低下の進行と思い受診が遅れたため増殖性硝子体網膜症を起こしていた。定期的眼底検査間隔の短縮や視力低下を自覚した時の速やかな受診指導の徹底が必要と思われた。

We reviewed 21 eyes in 14 patients treated for ocular complications of atopic dermatitis during the past 5 years. Initial diagnosis was cataract 8 eyes, retinal detachment 5, and cataract with retinal detachment in 8. Retinal detachment was detected in 2 of 8 eyes after surgery for cataract, necessitating additional scleral encircling and cryoretinopexy. Surgical outcome was gratifying. Retinal break was located along the vitreous base in the superior temporal quadrant in 6 of 12 retinal detachment cases. Proliferative vitreoretinopathy was the major cause for poor surgical outcome. Retinal detachment tended to be detected belatedly because of false assumption that the poor visual acuity was due to cataract only. We advocate funduscopic control at regular intervals in patients of atopic dermatitis and immediate detailed examination when visual deterioration sets in.