計画的虹彩切開術にもかかわらず散瞳不良であったフェムトセカンドレーザー白内障手術

Femtosecond laser-assisted cataract surgery in a case with poor mydriasis despite planned iridotomy

要約　目的：偽落屑症候群（PE）を有する高度散瞳不良例に対し計画的フェムトセカンドレーザー白内障手術（FLACS）を施行し，術前虹彩切開後のCCC径が2.6mmであったにもかかわらず無事に水晶体再建術を遂行できた症例の報告。

対象と方法：患者は96歳，女性。両眼の視力低下を主訴に受診した。両眼にPEあり，前房はやや浅め，白内障核硬化度はエメリー・リトル分類grade 3〜4で，両眼とも散瞳不良であった。チン小帯脆弱の可能性を説明したところFLACSを希望された。

結果：FLACS施行日の約2か月前に虹彩切開術を施行し，虹彩に数か所の切れ込みを入れた。FLACS当日の瞳孔径は3.7mmで，FLACSによるCCC径2.6mm通りにCCCを施行した。フェムトセカンドレーザーで核を8分割にマンゴーカット後，型どおり水晶体を処理し眼内レンズを挿入した。

結論：高度散瞳不良例に対するFLACS施行時には，術前にあらかじめ虹彩切開をしておくオプションがある。

Abstract　Purpose：We experienced a case in which a planned femtosecond laser cataractsurgery for severe mydriasis with pseudoexfoliation syndrome（PE）was performed and lens reconstruction was successfully achieved even though the continuous curvilinear capsulorrhexis（CCC）diameter was 2.6 mm after preoperative iridotomy.

Cases and Method：A 96-year-old woman visited our hospital with the chief complaint of decreased binocular visual acuity. She had PE in the both eyes, slightly shallow anterior chambers, and cataract classification of Emery-Little Ⅲ to Ⅳ. Mydriasis was observed, but the pupils hardly opened, and both eyes showed poor mydriasis. We explained to the patient that she might have weak zonules, and FLACS was performed at the request of the patient.

Results：First, iridotomy was performed about two months before the FLACS. Although several cuts were made in the iris, the pupil diameter on the day of FLACS was 3.7 mm. Therefore, CCC was performed by FLACS with a CCC diameter of 2.6 mm. After mango cutting the nucleus into eight parts with a femtosecond laser, the lens was processed according to the usual method, and an IOL was inserted.

Conclusion：When performing FLACS for patients with severe mydriasis, performance of an iridotomy before surgery is an option.