内境界膜下血腫を伴ったTerson症候群の1例

A case of Terson syndrome with hematoma posterior to the internal limiting membrane

　43歳男性に左後下小脳動脈瘤破裂によるクモ膜下出血が発症し，クリッピング術が即日行われた。経過は良好であった。手術の翌日に両眼に硝子体出血が発見され，その5週後に当科を受診した。視力は右0.1，左手動弁であり，Terson症候群と診断した。発症から2か月後に両眼に硝子体手術を行った。左眼には陳旧性の内境界膜下血腫があり，右眼には網膜前に黄白色沈殿物があった。術後経過は良好で，左右とも1.2の最終視力を得た。Terson症候群では硝子体出血だけでなく内境界膜下に出血することがあり，これが長期化すると黄斑前膜の形成や血液分解産物による網膜機能障害が起こる可能性があるので，早期手術が望まれる。

　A 43-year-old male developed rupture of aneurysm of left posterior cerebral artery. He received clipping surgery the same day. Vitreous hemorrhage was detected in both eyes on day 2 of surgery. When seen by us 5 weeks later,his visual acuity was 0.1 right and counting fingers left. We diagnosed him with Terson syndrome. He received vitreous surgery 2months after onset. We identified a hematoma posterior to the internal limiting membrane in the left eye. The right eye had yellowish deposits anterior to the retina. The postoperative course was uneventful. He obtained final visual acuity of 1.2 in either eye. This case illustrates that hemorrhage posterior to the internal limiting membrane is a liability in addition to vitreous hemorrhage in Terson syndrome. There is a possibility of formation of preretinal membrane and retinal dysfunction by disintegration of blood. We advocate early surgery for Terson syndrome.