全層角膜移植後の網膜剥離

Retinal detachment following penetrating keratoplasty

　角膜移植後の網膜剥離4例4眼について，臨床的特徴，手術時の問題点1角膜移植との関連を検討した。全例が全層角膜移植術後で，1眼は水晶体嚢内摘出術，1眼は眼内レンズ摘出術と前部硝子体切除術が併用されていた。初回手術として，全例に強膜バックリング手術を施行した。1眼で再剥離を来し硝子体手術を施行したが，拒絶反応を生じた。臨床像は通常の網膜剥離と同様であったが，特殊な光学系のため眼底周辺部の観察が困難であった。硝子体手術などの移植片に対して侵襲が大きい処置は，拒絶反応の契機となるため免疫抑制剤などによる予防処置が必要と考えられた。

We reviewed 4 eyes which developed retinal detachment after previous penetrating keratoplasty. Intracapsular cataract extraction had been performed in one eye. Removal of intraocular lens with anterior vitrectomy had been performed in one eye. Retinal reattachment was obtained in all the eyes by scleral encircling. One eye had to be treated by vitrectomy for retinal redetachment resulting in rejection of the corneal graft. The clinical features in the four eyes were similar to retinal detachment in general. As a peculiar feature, observation of the peripheral fundus was difficult due to the previous keratoplasty. Prophylactic measures with immunosup-pressive agents appeared to be indicated when planning vitreous surgery which may trigger an allograft rejection.