白内障術後早期に角膜穿孔した1例

A case of corneal perforation soon after cataract surgery

　93歳男性の右眼の白内障手術を行った。上方に強膜トンネルを作製し，10時と2時の位置にサイドポートを作った。水晶体乳化吸引術と眼内レンズ挿入を行ったが，核が固く，術中に後嚢が破損して手術に50分を要した。術翌日から，角膜浮腫，前房出血，前房混濁が生じ，3日目に角膜中央部が融解穿孔して眼内レンズが脱出した。6日目に角膜融解部は径7mmになり，壊死部切除と角膜輪部縫合による結膜被覆を行い，義眼を装着した。全経過中，原因菌は検出されなかった。術後感染症を予防するために，眼周囲の皮膚や腱毛の徹底的消毒，結膜嚢の消毒の強化，耳側切開の禁止，縫合の実施などが必要であると考えられた。

A 93-year-old male underwent cataract surgery in his right eye. We performed phacoemulsification-aspiration followed by intraocular lens implantation. A scleral tunnel was created at the 12 o'clock position with side ports at 10 and 2 o'clock. It took 50 minutes for the surgery due to the hard nucleus and intraoperative rupture of posterior capsule. Corneal edema, hyphema and turbid aqueous developed on day 2 of surgery, followed by melting of central cornea and prolapse of IOL the following day. The corneal melting, which enlarged to 7mm on day 6 of surgery, was excised and was covered by limbus-based conjunctival flap. No causative microorganism could be isolated during the whole postoperative course. This case illustrates the need of due precautions to avoid opportunistic postoperative infection.