硝子体内脱臼水晶体の治療

Pars plana lensectomy for dislocated lens in the vitreous

　58歳男性の硝子体内脱臼水晶体をオキュトームにより経毛様体扁平部水晶体切除術と硝子体切除術を施行し，良好な結果を得た。前医にて水晶体脱臼，水晶体偽落屑症候群，続発性緑内障と診断され，トラベクロトミー，レーザートラベクロプラスティーを施行されたが，眼圧が下降しないため当科を紹介され，輪状締結術，経毛様体扁平部水晶体切除術と硝子体切除術を施行し，薬物療法なしに眼圧を正常化できた。眼圧上昇の原因は水晶体偽落屑症候群よりも，脱臼水晶体によるぶどう膜炎からの続発性緑内障であったと考えられた。過去に硝子体内脱臼水晶体が自然破嚢し，それによるぶどう膜炎と続発性緑内障をおこしたが，全身状態が悪く，手術不可能で失明に至った症例を経験している。安全な術式が確立された今日，脱臼水晶体が成熟あるいは過熱白内障の状態であれば，重篤な合併症を起こす以前に積極的に手術すべきであろう。

A 58-year-old male presented with lens disloca-tion in the vitreous, pseudoexfoliation and elevated intraocular pressure with open angle in his right eye. Trabeculotomy and laser trabeculoplasty were futile in lowering the intraocular pressure. Removal of the dislocated lens by pars plana lensectomy was followed by spontaneous normalization of intraocular pressure. Uveitis due to dislocated lens seemed to be the cause for elevated intraocular pressure.

A 60-year-old male presented with luxated trans-parent lens, pseudoexfoliation and secondary open angle glaucoma in his left eye. After a 14-year follow-up period, the luxated lens became hyper-mature and ruptured spontaneously, resulting in severe lens-induced uveitis. Surgery was contrain-dicated due to poor general condition. As a retro-spect, an early pars plana lensectomy appears to have been the treatment of choice for this patient.