鈍的外傷による眼球破裂の検討

Review of globe rupture following blunt trauma

　過去5年間の鈍的外傷による眼球破裂21例21眼を検討した。年齢は25歳から92歳，平均67歳で，痴呆と強度近視が各6例あった。受傷の原因は，転倒11例，打撲9例，交通事故1例であった。白内障など手術歴が12眼にあった。眼球破裂の部位は，強膜16眼，角膜2眼，強角膜3眼で，15眼が角膜輪部に平行で，創の大きさは平均15.3mmであった。眼内レンズ挿入眼8眼すべてで眼内レンズが脱臼または脱出していた。有水晶体眼10眼中4眼で水晶体が偏位または脱出していた。網膜脱出が4眼，網膜剥離が15眼にあった。12眼に硝子体手術を行い，網膜剥離9眼中5眼で網膜が復位した。初診時視力は1眼以外は0.1末満であった。最終視力は，0.1から0.3が3眼，0.4以上が3眼であった。最終視力が光覚弁なしになる危険因子は，創の大きさが15mm以上（p＝0.017），網膜全剥離（p＝0.011），初診時に光覚なし（p＝0.015）であった。0.1以上の最終視力が得られる関係因子は，創の大きさが15mm以下（p＝0.029），網膜剥離なし（p＝0.031），硝子体手術施行（p＝0.031）であった。眼球破裂に対して硝子体手術は視力予後を好転させる一因子である。

We reviewed 21 eyes of 21 cases of eyeball rupture during the past 5 years. Their ages ranged from 25 to 92 years, average 67 years. Dementia and high myopia were present in 6 cases each. Past history of eye surgery was present in 12 eyes. The trauma was due to falling down 11 cases, blow 9 cases, and traffic accident 1 case. Globe rup-ture was located in the sclera in 16 eyes, in the cornea in 2 and corneoscleral in 3. The wound was parallel to the lim-bus in 15 eyes. The size of the wound averaged 15.3 mm. The intraocular lens was dislocated in all 8 pseudophakic eyes. The retina was prolapsed in 4 eyes. Retinal detachment was present in 15 eyes. Vitrectomy was performed on 12 eyes. The retina became reattached in 5 of 9 eyes of retinal detachment. Initial visual acuity was less than 0.1 in 20 eyes. Final visual acuity was 0.1 to 0.3 in 3 eyes, and 0.4 or over in 3 eyes. Risk factors for eventual blindness were wound size larger than 15 mm (p=0.017), total retinal detachment (p=0.011), and no light perception at the first visit (p=0.031). Final visual acuity of 0.1 or more was more frequent in eyes with wound smaller than 15 mm (p=0.029), no retinal detachment (p=0.031), and receiving vitreous surgery (p=0.031). Vitectomy may be beneficial in recov-ering vision after globe rupture.