1歳以下の両眼先天白内障に眼内レンズを挿入した5例

Bilateral surgery for congenital cataract with implantation of intraocular lens in infants under one year of age

要約　目的：先天白内障に対し両眼に眼内レンズを挿入した0歳児5例の報告。症例：過去6年間に先天白内障に対して手術を行った乳児5例10眼を対象とした。手術時の月齢はそれぞれ7，9，12，13，16週であった。3mmの角膜創を12時に作製し，粘弾性物質を前房に注入し，前囊切開の後皮質を吸引し，＋30Dのアクリル性眼内レンズを挿入した。全例に後囊と前部硝子体を切除した。術後6か月～4年（平均2.1年）の経過観察を行った。結果：最終観察時の屈折は－4D～＋10Dの範囲にあり，その平均値は術後6か月で＋3.27D，3年で－0.84Dであった。網膜剝離の発生はなく，2例2眼で瞳孔領にElschnig真珠の浸潤があり，硝子体手術を要した。結論：0歳児での先天白内障手術と眼内レンズ挿入術は，少なくとも術後6か月～4年の間は順調に経過した。術後の屈折値に個人差が大きいことが問題であり，合併症が生じる可能性に留意することが必要である。

Abstract.　Purpose：To report five infants who received bilateral cataract surgery with implantation of intraocular lens（IOL）. Cases：This retrospective study was made on 10 eyes of 5 infants treated during the past 6 years. They were aged 7, 9, 12, 13 and 16 weeks respectively at the time of cataract surgery. As a standard procedure, the cornea was incised at 12 o'clock position, viscoelastic material was injected into the anterior chamber, the lens cortex was aspirated, and a ＋30D acrylic IOL was inserted. Each eye received excision of posterior capsule and anterior vitreous. Cases were followed up for 6 months to 4 years, average 2.1 years. Results：Refraction at the last follow-up ranged from －4D to ＋10D. It averaged ＋3.27D 6 months after surgery and －0.84D 3 years after surgery. No eye developed retinal detachment. Two eyes needed vitrectomy for Elschnig pearls. Conclusion：Cataract surgery with IOL implantation in infants under one year of age was safe and effective during the period of observation. Postoperative refraction was widely variable among individuals. Due attention is needed for eventual postoperative complications.