自己閉鎖創眼内レンズ2次挿入術中に生じた駆逐性出血の1例

A case of expulsive hemorrhage following secondary intraocular lens implantation

（展示70）　高血圧の既往がある82歳女性の右眼に，眼内レンズ2次挿入術を行った。10年前に計画的嚢外摘出術が行われ，後発白内障に対して後嚢切開術が施行されていた。眼底には近視性脈絡膜萎縮以外の異常はなかった。眼内レンズ2次挿入術中に，硝子体圧上昇，血圧上昇，尿意，疼痛が生じ，投薬と排尿を行い，自己閉鎖創を縫合して手術を終った。術翌日に，視力光覚弁，眼底透見不能，眼圧11mmHgであった。超音波検査とMRIで，高度の脈絡膜出血と駆逐性出血が発見された。強膜切開と硝子体手術を行い，脈絡膜剥離と脈絡膜出血は消失した。自己閉鎖創手術は眼圧の変動が少ないとされているが，本例では複数の危険因子に加えて，術前に後嚢切開が行われていたために。術中操作時には解放状態にあったと考えられる。

A 82-year-old female with systemic hypertension underwent secondary intraocular lens (IOL) implantation in her right eye. She received planned extracapsular cataract extraction 10 years before followed by capsulotomy for aftercataract. There was no fundus abnormalities except myopic choroidopathy. During IOL implantation, she developed ocular pain, desire to urinate, systemic hypertension and raised vitreous pressure. The surgery was otherwise uneventful and the corneal wound was closed by suturing. The following day, the visual acuity was down to light perception with opaque media. Echography and magnetic resonance imaging showed choroidal detachment with expulsive hemorrhage. Sclerotomy and vitreous surgery led to disappearance of choroidal lesions. While self-sealing eye surgery had been regarded to be relatively safe, numerous risk factors in this patient appeared to have led to expulsive hemorrhage.