核が硝子体中に自然落下した過熟白内障の1例

Spontaneous dislocation of lens nucleus in a case of mature cataract

　76歳女性が1週前からの左眼痛と頭痛で受診した。10年前に白内障を指摘されたが放置していた。矯正視力は右0.9，左指数弁で，眼圧は右17mmHg，左25mmHgであった。左眼に角膜浮腫と前房に強い炎症所見があった。瞳孔領に破嚢した水晶体嚢の断端とその赤道部があり，その後下方に水晶体核と硝子体混濁があった。過熟白内障に続発した水晶体核の自然落下と診断し，手術を行った。水晶体核を前房内に移勤させ，強角膜切開創を通じて娩出し，硝子体手術で残存皮質と硝子体混濁を除去した。水晶体核の後方落下は，過熟白内障に伴う水晶体嚢とチン小帯の脆弱化がその原因であると推定した。

A 76-year-old female presented with left ocular pain and headache since one week before. She had been diagnosed with cataract 10 years before. Her visual acuity was 0.9 right and counting fingers left. The intraocular pres-sure was 17mmHg right and 25mmHg left. The left eye showed corneal edema and inflammation in the anterior cham-ber. Remnants of disrupted lens capsule were seen in the pupillary area. The lens nucleus was present posterior to the pupil. The anterior vitreous was turbid. We diagnosed her with spontaneous dislocation of lens nucleus following ma-ture cataract. We extracted the lens nucleus through a corneoscleral wound after bringing the nucleus into the anterior chamber. The disrupted lens capsule and vitreous opacity were removed by vitrectomy. The dislocation of lens nu-cleus seemed to be due to fragile lens capsule and zonules in long-standing mature cataract.