Iris retraction syndromeの合併が疑われた裂孔原性網膜剝離の1例

Presumed iris retraction syndrome in a case of rhegmatogenous retinal detachment

要約　背景：Iris retraction syndrome（仮称：虹彩後退症候群）とは，網膜剝離で前房圧が後房圧よりも高くなり，虹彩が後方に移動し，虹彩周辺部が段状に陥没する状態をいう。目的：虹彩後退症候群が疑われた網膜剝離の症例の報告。症例：59歳女性が3日前からの左眼の眼痛と視力低下で受診した。右眼は20年前に白内障手術を受け，左眼は幼少時から弱視であった。所見：矯正視力は右1.0，左0.08で，眼圧は右14mmHg，左7mmHgであった。左眼は前房が深く，周辺部で虹彩が段状に陥没していた。超音波検査で左眼に網膜剝離と顕著な脈絡膜剝離があった。ステロイド薬の点眼で眼痛は軽快し，眼圧は14mmHgになった。左眼眼底の上方に馬蹄形裂孔が発見され，その周囲に光凝固を行った。初診から7日後には網膜剝離と脈絡膜剝離は消失し，視力は0.2になった。その翌月に白内障手術を行い，0.6の視力を得た。以後5か月後の現在まで再発はない。結論：本症例は裂孔原性網膜剝離に併発した虹彩後退症候群であったと推定される。

Abstract.　Purpose：To report a case of rhegmatogenous retinal detachment with suspected iris retraction syndrome. Case：A 59-year-old female presented with pain and impaired vision in her left eye since 3 days before. She had received cataract surgery in the right eye 20 years before. The left eye had been amblyopic since childhood. Findings：Corrected visual acuity was 1.0 right and 0.08 left. Intraocular pressure（IOP）was 14 mmHg right and 7 mmHg left. The left eye showed deep anterior chamber with the iris periphery displaced posteriorly. Echography showed retinal detachment with extensive choroidal detachment in the left eye. Instillation of corticosteroid was followed by relief of pain with IOP rising to 14 mmHg. A horseshoe tear with retinal detachment was found in the upper sector of left fundus. Photocoagulation surrounding the hole was followed by disappearance of retinal and choroidal detachment 7 days after her initial visit. Visual acuity in the left eye improved to 0.6 after cataract surgery. She has been doing well for 5 months until present. Conclusion：This case is suspected of iris retraction syndrome secondary to rhegmatogenous retinal detachment.