両眼の緑内障手術後に生じたuveal effusionの1例

A bilateral case of uveal effusion following trabeculectomy

（P1-1-9）　66歳女性の両眼の慢性閉塞隅角緑内障と白内障手術に対して，超音波水晶体乳化吸引術，眼内レンズ挿入術，線維柱帯切除術が他医で行われた。3週後に脈絡膜剥離が生じ，脈絡膜下液排液後に再発して，手術から6か月後に紹介され受診した。両眼に強膜切除術を行い，網膜剥離と脈絡膜剥離は消失した。眼軸長は正常で，小眼球ではなかった。術中に切除した強膜は肥厚しており，強膜異常による蛋白流出障害がuveal effusionの原因であると推定した。赤外螢光眼底造影で脈絡膜血管の透過性亢進があり，この所見は手術後に軽快した。非小眼球であっても強膜に異常があると緑内障手術による侵襲でuveal effusionが発症しうること，そして緑内障手術後に脈絡膜剥離が遷延するときには強膜切除術が奏効することを本症は示している。

A 66-year-old female had received surgery for cataract and chronic closed-angle glaucoma by phacoemulsifica-tion aspiration, intraocular lens implantation and trabeculectomy in both eyes. Bilateral choroidal detachment was detected 3 weeks later. She was referred to us for reccurrence of choroidal detachment after drainage of subchoroidal fulid 6 months after the initial surgery. Retinal and choroidal detachment disappeared following sclerectomy in both eyes. Both eyes had normal axial length and were not nanophthalmic. The surgically obtained scleral tissue showed thickening, suggesting that consequent abnormality in the transscleral protein transport system was causatively related to the uveal effusion. Indocyanine green angiography showed hyperpermeability of choroidal vessels which disappeared after sclerectomy. This case illustrates that uveal effusion is a liability following trabeculectomy in eyes with scleral abnormality and that scleretomy may be effective for prolonged postsurgical uveal effusion.