駆逐性出血に対する待機硝子体手術

Planned vitreous surgery for expulsive hemorrhage

要約　目的：白内障手術中の駆逐性出血に待機硝子体手術を行った症例の報告。症例：82歳男性が白内障手術の合併症で受診した。3年前に左眼の白内障手術が他院で行われ，1.0の視力が得られた。1日前に右眼の水晶体乳化吸引術中に後囊が破損し，囊外摘出術が行われた。脱出硝子体を切除し，眼内レンズを挿入した。その翌日に前房出血と硝子体出血があり，当科に紹介された。所見と経過：右眼視力は光覚弁，眼圧は15mmHgで，網膜全剝離と脈絡膜出血があった。16日後に硝子体手術，輪状締結術，シリコーンオイル置換術を行い，網膜は復位した。眼圧上昇と網膜再剝離に対し2回の硝子体手術を行った。発症から17か月後の現在，網膜は復位し0.09の視力を得ている。結論：駆逐性出血に対し溶血期になってから硝子体手術を行い，積極的な排血と網膜復位術で視機能を温存できた。

Abstract.　Purpose：To report a case treated by planned vitrectomy for expulsive hemorrhage following cataract surgery. Case：An 82-year-old male presented with complication of cataract surgery. He had received uneventful cataract surgery in his left eye 3 years before. His right eye received extracapsular cataract extraction after capsular rupture during phacoemulsfication. He was referred to us the following day for hyphema and vitreous hemorrhage. Findings and Clinical Course：Visual acuity was light perception with intraocular pressure of 15 mmHg. The right eye showed total retinal detachment and signs of choroidal hemorrhage. Vitrectomy with scleral encircling was performed 16 days later resulting in retinal reattachment. After 2 additional surgeries during the ensuing 17 months,the retina is reattached with visual acuity of 0.09. Conclusion：This case illustrates that planned vitrectomy may be effective for expulsive hemorrhage after hemolysis has set in.