Spontaneous hyphemaを生じた小児の1例

Spontaneous hyphema in a child

要約　目的：明確な外的誘因がなく発症する前房出血はspontaneous hyphemaと呼称される。今回，外傷や手術侵襲などの既往がなく前房出血を生じた小児の症例を経験したので報告する。

症例：7歳，男児。右結膜充血と突然の眼痛を自覚し，近医を受診した。右前房出血の診断で，精査加療目的で当院を紹介され受診となった。初診時の右矯正視力は光覚なし，右眼圧は60mmHgであった。右前眼部所見上，前房内を出血が充満し，瞳孔および虹彩紋理は透見不能であった。外傷歴はなく，家庭環境も良好であり，四肢体幹に外傷痕がないため虐待の可能性は否定的であった。全身検査でも出血性素因などの異常はなかった。入院にて，安静・薬物加療を行うも，出血の消退および眼圧の下降が得られなかったため，入院3日後に前房内血腫除去術を施行した。術後角膜染血症などの合併症はなく，右矯正視力は1.2まで改善し，前房出血の再発もなかった。

結論：小児に発生したspontaneous hyphemaでは，早期に前房内血腫除去術を施行したことで不可逆的障害を残さず，良好な視力を得ることができた。

Abstract　Purpose：Hyphema without obvious external triggers is called spontaneous hyphema. We report a case of a child who developed hyphema without external triggers such as trauma.

Case：The patient is a 7-year-old boy. He was diagnosed with right hyphema with conjunctival injection and sudden pain of right eye, and was referred to our department. At the first visit, the visual acuity of right eye was no light perception, and the intraocular pressure of right eye was over 60 mmHg. Hyphema filled the anterior chamber, and the pupil and iris pattern were invisible. We suspected traumatic hyphema, but he had no history of trauma, and there was no possibility of child abuse. There were no abnormalities such as hemorrhagic predisposition with blood examination. We started medical treatment, but intraocular pressure did not decrease, so we had operation 3 days later. Intraocular hematoma was removed with bimanual I/A and vitreous cutter. The visual acuity of right eye improved to 1.2 after surgery, and no rebleeding or corneal staining was observed during the follow-up period of 1 year.

Conclusion：We experienced spontaneous hyphema in a child. We removed hyphema early, and he got good postoperative visual acuity without irreversible disorders.