嘔吐後に水晶体脱出を生じ，病態が悪化した眼球破裂の1例

Lens prolapse following vomiting in a case of eyeglobe rupture

要約　目的：眼球破裂で入院後，嘔吐により水晶体眼外脱出を生じ病態が悪化した症例の報告。症例：73歳女性。野球ボールが右眼に当たり，眼瞼周囲の腫脹と視力低下を認め受診した。眼窩CTで水晶体眼内落下を認め，右眼眼球破裂の診断で緊急手術を予定したが，止血目的にトラネキサム酸点滴開始後に悪心と嘔吐が生じ，眼痛が増悪したために手術を中止した。翌日のCT検査で水晶体の眼外脱出を認め，第3病日全身麻酔下に一期的硝子体手術を行った。その後2回の追加手術を行い，シリコーンオイル下で網膜は復位している。結論：眼球破裂では，眼窩内圧上昇により眼球内容脱出が生じやすく，全身麻酔下手術で眼窩内圧上昇を予防することが望ましい。

Abstract.　Purpose：To report a case who developed lens prolapse following vomiting before surgery for eyeglobe rupture. Case：A 73-year-old woman visited our emergency ward after being hit by a flying baseball in the right eye. Findings：The right eye showed periocular swelling with visual acuity of light perception. Computed tomography showed displacement of the lens in the vitreous cavity. The right eye was diagnosed with eyeglobe rupture. Emergency surgery had to be postponed after she developed nausea and vomiting following infusion of tranexamic acid. The lens was luxated externally the following day. Surgery was performed on day 3 of injury. The retina has been attached under silicone oil 17 months until present. Conclusion：This case illustrates that due precaution is needed as intraocular tissue may prolapse following rise in intraocular pressure in ruptured eyeglobe.