最終的に眼内レンズ縫着術が奏効した外傷性毛様体解離による低眼圧黄斑症の1例

A case of hypotonic maculopathy caused by traumatic cyclodialysis finally cured by transscleral suture fixation of intraocular lens

要約　目的：広範囲の外傷性毛様体解離に伴う低眼圧黄斑症が遷延し，種々の手術で軽快せず，最終的に眼内レンズ縫着術が奏効した1例の報告。

症例：56歳の男性が3か月前に左眼を殴打され，前房出血，広範囲の毛様体解離，低眼圧が生じた。前房出血が消退した後，眼圧は8mmHg以下になり，低眼圧黄斑症が生じたため，当科を紹介され受診した。

所見と経過：矯正視力は右1.2，左0.5で，眼圧は右17mmHg，左8mmHgであった。左眼は浅前房で，外傷性白内障と低眼圧黄斑症があった。前眼部OCTで270°にわたる毛様体解離があった。薬物療法は無効で，受傷14か月後に経強膜毛様体縫合術，水晶体切除，硝子体手術と20％SF₆によるガスタンポナーデを行った。低眼圧黄斑症が続いたため，受傷17か月後に毛様体解離部の冷凍凝固と強膜輪状締結術を行った。低眼圧黄斑症が続いたため，その2か月後に眼内レンズ縫着術を行った。1週間後に眼圧は43mmHgになり，低眼圧黄斑症は消退した。以後，眼圧と眼底は安定し，1.5の最終視力を得ている。

結論：遷延する毛様体解離に伴う低眼圧黄斑症は，受傷から長期間を経ても，手術療法が奏効し，本症例では人工水晶体が有効であった。

Abstract　Purpose：To report a case of traumatic cyclodialysis with hypotonic maculopathy that persisted after various transscleral suture of intraocular lens（IOL）.

Case：A 56-year-old male was referred to us for hypotonic maculopathy in his left eye. He had received severe trauma in the left eye 3 months before while involved in a fight. The left eye developed, reportedly, hyphema, extensive cyclodialysis, and ocular hypotony resulting in hypotonic maculopathy.

Findings and Clinical Course：Corrected visual acuity was 1.2 right and 0.5 left with intraocular pressure of 17 mmHg and 8 mmHg respectively. The left eye showed shallow anterior chamber, traumatic cataract and traumatic maculopathy. Cyclodialysis was present involving 270 degrees of whole circumference. Attempts with medical or surgical treatments proved futile including vitrectomy with gas tamponade with 20％ SF₆. Nineteen months after injury, IOP was sutured to the sclera. IOP rose to 43 mmHg one week later followed by resolution of maculopathy. He has been doing well until present with visual acuity of 1.5.

Conclusion：Transscleral suture of IOP was effective in the present case of protracted hypotensive maculopathy secondary to traumatic cyclodialysis.