テノン囊内麻酔により前房出血，硝子体出血および球後出血をきたした1例

A case of hyphema,vitreous and retrobulbar hemorrhage following Tenon capsule anesthesia

　83歳男性の右眼に白内障手術を予定した。右眼には開放隅角緑内障と約-13Dの近視があり，左眼には落屑緑内障があった。全身的に高血圧と多発性脳梗塞の既往があった。通常の方法で2％キシロカインをテノン囊に注入した。その直後に隅角の1時の部位から前房出血が起こったので手術を中止した。その10分後には出血が前房を満たしていた。翌日に，前房出血，大量の硝子体出血，球後出血が起こっていた。術3か月後にも，前房出血と大量の硝子体出血が残っている。テノン囊内麻酔は手技が容易で合併症が少ないとされているが，高度近視や循環障害がある症例では重篤な合併症が起こりうる危険があり，注意が必要である。

We scheduled cataract surgery in the right eye of a 83-year-old male. His right eye had myopia of-13 diopters and had been treated for open-angle glaucoma. His left eye had capsular glaucoma. He had systemic hypertension and history of cerebral infarction. His right eye received the routine procedure of injection of 2％xylocaine into the Tenon capsule. Immediately after,hemorrhage started from the chamber angle at the 1 o'clock position necessitating abortion of surgery. Ten minutes later,the anterior chamber was filled by blood. Hyphema,massive vitreous hemorrhage and retrobulbar hemorrhage had developed the next day. Hyphema and vitreous hemorrhage were still present 3months after surgery. This case illustrates that due precaution is necessary in performing Tenon capsule anesthesia in the presence of high myopia and systemic vascular lesions.