線維柱帯切除術後に生じた脈絡膜血腫の1例

A case of suprachoroidal hemorrhage following trabeculectomy

　59歳男性が右眼の高眼圧で紹介を受け受診した。幼少時から両眼に-7.5Dの近視があった。左眼は35歳の頃失明し，受診時には水晶体全脱臼と網膜全剥離があった。右眼には水晶体摘出術と線維柱帯切開術の既往があった。薬物治療で右眼眼圧が48mmHg以下に下降しないため，マイトマイシンC併用の線維柱帯切除術を行った。術翌日の眼圧は3mmHgの低眼圧で前房の形成があったが，脈絡膜剥離が内方周辺部にあり，以後これが増悪して胞状の脈絡膜全剥離になった。術後19日目の磁気共鳴画像検査MRIで脈絡膜血腫が同定された。以後眼圧は15mmHgに維持され，血腫は術後50日で消失し，術前の手動弁の視力が0.4に改善した。この脈絡膜血腫は駆逐性出血に準じる機序によって生じたと解釈され，術前の高眼圧，無水晶体眼，強度近視，加齢，術後の低眼圧が危険因子として関係したと推定された。

A 59-year-old man was referred for glaucoma in his right eye. He had had myopia of -7.5 diopters in both eyes since childhood. His left eye had become blind due to total retinal detachment at the age of 35 years. He had a history of cataract surgery and trabeculectomy in his right eye. After medications failed to control the intraocular pressure (IOP) below 48mmHg, we performed trabeculectomy with adjunctive mitomycin C on his right eye. On day 2 of surgery, the anterior chamber was well formed with the IOP of 3mmHg. Choroidal detach-ment was present in the nasal periphery. It developed into total and bullous choroidal detachment. Magnetic resonance imaging (MRI) showed the presence of suprachoroidal hematoma on day 19 of surgery. Thereafter, the IOP remained at about 15mmHg. The suprachoroidal hematoma disappeared spontaneously on day 50 of surgery. The corrected visual acuity improved from the presurgical hand motion to 0.4. It appeared that expulsivehemorrhage induced the suprachoroidal hematoma due to risk factors including elevated IOP at the time of surgery, aphakia, myopia, ageing and postoperative hypotony.