前囊染色に用いたインドシアニングリーンが原因と考えられた白内障術後toxic anterior segment syndromeの1例

A case of toxic anterior segment syndrome following cataract surgery with adjunct use of indocyanine green

要約　目的：白内障術後にtoxic anterior segment syndrome（TASS）が生じ，硝子体手術を必要とした症例の報告。症例：70歳女性が右眼の感染性眼内炎の疑いで紹介され受診した。2日前にインドシアニングリーン（ICG）を併用する白内障手術を受けていた。所見：右眼矯正視力は0.15で，角膜浮腫，Descemet膜皺襞，前房にフィブリン析出と細胞増加があった。炎症に比べて重症感がなく，TASSを疑った。ステロイド点眼で消炎せず，前房洗浄で起炎菌は同定されず，眼内炎が持続した。初診から7日後に硝子体手術を行った。9日後に退院し，1.5の最終視力を得た。結論：原因が手術で除去できる場合には，早期の手術を行うべきである。

Abstract.　Purpose：To report a case of toxic anterior segment syndrome following cataract surgery with adjunct use of indocyanine green（ICG）. Case：A 70-year-old female was referred for suspected infectious endophthalmitis. She had received cataract surgery using ICG 2 days before. Findings：Corrected visual acuity was 0.15. The affected eye showed corneal edema,folds in Descemet membrane,and cells and fibrin in the anterior chamber. TASS was suspected as subjective symptoms were disproportionately moderate in comparison to objective findings. Topical corticosteroid was not effective. No causative microorganism was isolated from the aqueous. Vitrectomy was performed to remove the presumedly present ICG 7 days after her initial visit. The patient was discharged after rapid improvement 9 days later with final visual acuity of 1.5. Conclusion：This case illustrates that early surgery may be effective for TASS when the underlying cause is reasonably identifiable.