高度遠視の真正小眼球症Nanophthalmosに伴うuveal effusionの手術による治療

Surgical treatment for uveal effusion in nanophthalmic eyes

　両眼とも＋14Dの高度遠視で，眼軸長18mmのnanophthalmos （真正小眼球症）の27歳の女性に，全周に脈絡膜剥離を伴う高度の胞状の網膜剥離が発生し，uveal effusionと診断された．片眼は他院で数度の網膜剥離手術をうけていたが難治であった．

　この両眼に赤道部で4直筋の下のみを除いて全周の強膜に幅4mm，厚さ4分の3層の輪状の層状強膜切除と，その底部にほぼ2mm径の全層強膜切除による開窓を行った．

　術後uveal effusionは翌日より吸収傾向を示し，脈絡膜剥離は数週間で速やかに吸収され，半年後には網膜は完全復位した．

　手術中強膜は厚く硬かったので，真正小眼球症におけるuveal effusion　の発生は眼内液の強膜を通る眼外への流出障害によると思われた．

　nanophthalmosに伴うuveal effusion　に対して，強膜の輪状層状切除術と強膜開窓術は有効な治療法であり，渦静脈減圧術は必要ないと思われた．

A 27-year-old female presented with marked non-rhegmatogenous retinal detachment with choroidal detachment in both eyes. The condition had persisted for 3 years before visiting us.

Both eyes were diagnosed as nanophthalmos, with the horizontal axis of the eyeglobe measuring 18 mm. High hypermetropia of +14D was present. Both eyes were judged as uveal effusion occurring in nanophthalmos.

We treated both eyes by surgery, performing lamellar resection of the sclera, three quarters in depth and 4 mm in width around the whole equator, excepting the site beneath the 4 rectus muscles. Additionally, we perfor-med sclerectomy, 2 mm in diameter, at 4 sites at the bottom of the resected sclera. During surgery, the sclera was conspicuously thick and rigid as leather. We could drain profuse serous subchoroidal fluid through the sclerotomies. The retinal and choroidal detachment started to subsied immediately after surgery to com-pletely disappear 6 months later.

Our findings seemed to indicate that the uveal effu-sion in nanophthlamic eyes was caused by impeded outflow of intraocular fluid through the thick and rigid sclera. Surgery by lamellar scleral resection and scler-otomy may prove beneficial in this condition.

Rinsho Ganka (Jpn J Clin Ophthalmol) 40(11) : 1236-1238. 1986