放射状角膜切開術後に生じた巨大網膜裂孔にうよる網膜剥離の両眼例

Bilateral retinal detachment with giant break in a case after radial keratotomy

　角膜屈折矯正手術のひとつである放射状角膜切開術（radial keratotomy：RK）を施行された眼に何らかの疾患を併発し，眼内手術を行わなければならない場合，その手術侵襲が角膜や眼球にどのような影響を与えるかについての報告は少ない。今回，筆者らはRK施行8か月後に両眼に鈍的外傷を受け，巨大裂孔による網膜剥離をきたした症例に対し，一眼は硝子体手術を，他眼は強膜インプラントを施行し，良好な結果を得た。しかし，術中角膜切開創による術野の視認性の悪化と術後の角膜内皮細胞数の有意な減少，および角膜形状解析で角膜形状の扁平化が見られた。RK施行に際しては術前に十分な眼底検査が必要であると考えた。

A 25-year-old male underwent radial keratotomy for myopia 8 months before. He was hit by the fist when involved in a fight. Left visual field defect was noted the following day. He was referred to us 4 days after the fight. Both eyes showed 16 radial corneal scars leaving a clear optical zone of 4 mm across in the central cornea. Traumatic angle recession was present in both eyes. Retinal detachment was present in both eyes. The right eye showed oral tear extending 120 degrees of the circumference. A similar tear was present extending 180 degrees. The right eye was successfully treated by scleral implantation and the left by vitreous surgery. Postsurgically, both eyes showed corneal flattening and decreased endothelial cells. We advocate to perform a thorough evaluation of the fundus prior to refractive corneal surgery.