黄斑円孔術後早期に発症した交感性眼炎の1例

A case of sympathetic ophthalmia nine days after macular hole surgery

　62歳女性の左眼黄斑円孔に対して，硝子体手術，内境界膜切除，水晶体乳化吸引術，眼内レンズ挿入術を行った。術後8日目に前房フィブリン膜が左眼に生じ，その翌日に虹彩炎と漿液性網膜剥離が右眼に起こった。右眼の蛍光眼底造影で黄斑部に蛍光漏出と色素の網膜下貯留を確認した。両眼の交感性眼炎と診断した。全身と局所のステロイド薬投与と抗生物質投与で両眼の炎症所見は速やかに消失し，右眼視力は0.6から1.0に回復した。HLA検査でDR4陽性であった。黄斑円孔に対する白内障硝子体同時手術後の早期に交感性眼炎が起こりうることを示す症例である。

A 62-year-old female underwent surgery for idiopathic macular hole in her left eye. She received vitrectomy, peeling of internal limiting membrane, phacoemulsification-aspiration, and intraocular lens implantation. The treated eye developed fibrinous exudates in the anterior chamber 8 days after surgery. Her right eye developed iritis and serous retinal detachment the following day. Fluorescein angiographic findings in the right eye were compatible with those of sympathetic ophthalmia. Systemic corticosteroid and antibiotics induced prompt resolution of inflammation in both eyes. Her right visual acuity recovered from 0.6 to 1.0. She was positive for HLA DR-4. This case illustrates that sympathetic ophthalmia may develop as early as 9 days after simultaneous cataract and vitreous surgery.