眼内レンズ強膜内固定術にみられた術後合併症

Complications after intrascleral posterior chamber intraocular lens fixation

要約　目的：眼内レンズ（IOL）強膜内固定術の術後合併症と対処の報告。対象と方法：対象は初期の5例5眼（無水晶体眼2眼・IOL脱臼3眼）。術式は当初Gaborの原法に従い，続いて太田のY-fixation techniqueに改変を加えた。結果：術後合併症はIOL脱臼，低眼圧（各1眼；IOL縫着術にて対処），高眼圧（偽落屑症候群の1眼；濾過手術にて対処）。低眼圧眼でIOL支持部が強膜を貫き，毛様体剝離を起こしていることが光干渉断層計で示された。結論：本術式の習得には習熟曲線がみられ，原疾患による合併症が起こることがある。手技の工夫，適したIOLの選択，合併症への対応が重要である。

Abstract.　Objective：To describe the postoperative complications and modifications of the techniques for intrascleral posterior chamber intraocular lens（IOL）fixation. Methods：This study reviewed the records of early five cases that had intrascleral IOL fixation. Preoperative lens status was aphakic in two eyes and dislocated IOL in three eyes. For surgical techniques, we first employed the original techniques invented by Gabor, and later modified the Y-fixation technique developed by Ohta. Results：The postoperative complications were IOL dislocation（1 eye）, hypotony（1 eye）；both of which cases were reoperated successfully with conventional scleral suture fixation, and ocular hypertension（1 eye of pseudoexfoliation syndrome；trabeculectomy was later performed as treatment）. In a hypotony case, optical coherence tomography revealed that choroidal detachment was induced by haptic mispositioned in suprachoroidal space. Conclusions：A technique for intrascleral IOL fixation has a learning curve and its outcome is vulnerable to background ocular conditions. Modifications of the techniques, selection of IOL, and treatments for complications are keys to successful outcome.