統合失調症の自傷行為による強膜裂傷および鋸状縁断裂網膜剝離に対する硝子体手術

Vitreous surgery for scleral rupture and retinal detachment with oral tear following self-inflicted injury by a schizophrenic

統合失調症の22歳男性が，妄想体験に伴い発作的に自ら眼球摘出を試みた。矯正視力は右眼光覚弁，左眼1.2であり，右眼の眼圧は低眼圧で測定不能であり，右眼に強い前房出血があった。眼窩CTで右眼球が虚脱し，強膜裂傷が推定された。硝子体手術で鋸状縁断裂による網膜剝離が広範囲にあり，冷凍凝固，輪状締結，20％ SF₆ガスを併用した。網膜は復位し，1.0の矯正視力を得た。以後の5年間，自傷行為はない。統合失調症患者が発作的に眼球摘出を試みたが，自傷行為の反復がなく，積極的な手術治療で視力が維持できた例である。

A 22-year-old schizophrenic male attempted self-enucleation during an attack of illusion. His corrected visual acuity was light perception right and 1.2 left. The right eye showed hyphema and was extremely hypotonic. Orbital CT showed collapsed right eyeball,suggesting scleral rupture. During vitreous surgery,extensive retinal detachment was present secondary to oral tear. The retina became reattached with visual acuity of 1.0 after cryopexy,scleral encircling,and tamponade with SF₆ gas. There has been no attempt at self-injury during 5 years until present. This case illustrates that fair outcome is possible by aggressive surgical approach after self-inflicted enucleation by a schizophrenic.