超音波白内障手術中に発症し手術続行が困難であった上脈絡膜滲出液貯溜の2例

Two cases of suprachoroidal effusion during cataract surgery

要約　目的：白内障手術中に上脈絡膜滲出が突発した2症例の報告。症例：75歳男性の右眼と71歳女性の左眼に白内障手術を行った。2例とも全身または眼に格別の問題はなかった。2例とも超音波核乳化吸引を終了し，超音波チップを前房から抜去した直後に前房が消失し，眼圧が上昇した。1例は前房形成が不全のまま眼内レンズを挿入した際に破囊した。他の1例では皮質吸引中に手術を中断し，翌日に残存皮質吸引と眼内レンズを挿入した。2例とも術後に脈絡膜剝離があったが，滲出液はそれぞれ2週間後と3か月後に自然に消失した。結論：上脈絡膜への滲出液貯溜は稀ではあるが重大な白内障手術の術中合併症である。破囊や脈絡膜出血などを回避するために，すみやかに創口を閉鎖し，翌日以降に手術を延期すべきである。

Abstract.　Purpose：To report two cases who developed suprachoroidal effusion during cataract surgery. Cases：Cataract surgery was performed on the right eye of a 75-year-old male and the left eye of a 71-year-old female. Both cases were free of systemic or ocular problems. Just when the ultrasound tip was removed after uneventful phacoemulsification-aspiration in both cases, the anterior chamber disappeared followed by acute elevation of intraocular pressure. One case showed ruptured capsule during insertion of intraocular lens with the anterior chamber still absent. Surgery was discontinued in the other case. The residual cortex was removed and intraocular lens was inserted the following day. Both cases showed choroidal detachment after surgery. It disappeared spontaneously after 2 weeks and 3 months respectively. Conclusion：Suprachoroidal effusion is a rare but serious complication during cataract surgery. Immediate closure of corneal wound and postponing surgery until the following day is a simple and effective means to prevent further complications.