線維柱帯切除術の1週後に上脈絡膜出血を起こした1例

A case of suprachoroidal hemorrhage one week after trabeculectomy

（P4-3-4）　49歳女性が左眼の視力障害で受診した。先天緑内障のために幼児期に両眼に手術を受けていた。右眼は眼球癆で、左角膜は白濁し，視力は手動弁，眼圧は42mmHgであった。左眼にマイトマイシンC併用の線維柱帯切除術を行った。眼圧は下降したが，術後7日目に眼痛と嘔吐が突発し，上脈絡膜出血が起こった。網膜剥離と硝子体出血が併発していた。人工角膜縫着後に硝子体手術とシリコーンタンポナーデを行い，自己角膜を再縫着した。術中所見として網膜に強い増殖性変化があった。線維柱帯切除後に上脈絡膜出血が起こり，眼底が透見しにくいときには積極的に硝子体手術を行うことが推奨される。

A 49-year-old female presented with progressive loss of vision in her left eye. She had been operated for bilateral congenital glaucoma at the age of 3 years. Her right eye was phthisic. Her left cornea was opaque with the visual acuity of hand motion. The intraocular pressure (IOP) was 42 mmHg. The left eye was treated by uneventful trabeculectomy with intraoperative mitomycin C. After normalization of IOP, she developed suprachoroidal hemorrhage with ocular pain and vomiting. Retinal detachment and choroidal hemorrhage were also present. We performed suturing of corneal prosthesis, vitrectomy and silicone oil tamponade. Massive proliferative lesions were detected during surgery. This case illustrates the need for early intervention by vitrectomy when suprachoroidal hemorrhage develops after trabeculectomy in an eye with hazy media.