自傷癖のある知的障害者の白内障手術

Cataract surgery in mentally deficient persons with habitual self-traumatism

　眼自傷癖のある知的障害者5名の8眼に白内障手術を行った。年齢は17歳から50歳，平均33歳であり，精神障害者と痴呆者は含まれない。2例3眼には水晶体摘出術，3例5眼には眼内レンズ挿入術を合わせて行った。術後の視力改善に伴い，全例で眼自傷行為はなくなった。術後2か月目に網膜剥離が1例に，18か月後に角膜変性による視力障害が他の1例に起こり，眼自傷行為が再発した。患者が住んでいる施設での日常生活動作の改善度は，施設指導員の報告では，無水晶体者と眼内レンズ挿入者との間で明らかでなかった。重度知的障害者では，視力障害が眼自傷行為発現の原因である可能性があるので，速やかに視力障害を治療することが望ましい。

We performed cataract surgery on 8 eyes of 5 mentally deficient persons. All had a habit to repeatedly rub or push the eye. Their ages ranged from 17 to 50 years, average 33 years. Cataract extraction was performed on 3 eyes of 2 persons. Additional intraocular lens implantation was performed on 5 eyes of 3 persons. Following improved visual acuity after surgery, all the persons discontinued acts of self-traumatism to the eye. Self-traumatism recurred in 2 persons, following retinal detachement 2 months after surgery in one and visual deterioration due to corneal degenera-tion 18 months after surgery in another. According to the report by the staff of institutions where the patients were staying, there was no difference in the behavior in daily life between aphakic and pseudophakic persons. The findings show that self-traumatism to the eye may be induced by decreased vision in mentally deficient persons, suggesting the need of early visual rehabilitation in such cases.