外傷性毛様体解離に著明な浅前房を合併し治療に難渋した1例

An intractable case of traumatic cyclodialysis with remarkable shallow anterior depth

要約　目的：毛様体解離における部位の同定は超音波生体顕微鏡（UBM）や前眼部光干渉断層計（OCT）が有効であるが，設置している機関は少ない。今回，筆者らは外傷性毛様体解離に著明な浅前房を合併したために解離部位や範囲が同定できず治療に難渋した症例を経験したので報告する。

症例：33歳，男性。ラグビーの試合中に右眼を鈍的に受傷した。1週間後に当科を紹介され受診し，右眼視力は0.8，右眼圧8mmHg，水晶体の前方移動に伴う浅前房を認め，毛様体解離が疑われた。

結果：自然治癒を期待し経過観察したが，低眼圧の持続，視力低下，浅前房，脈絡膜皺襞の悪化を認め，受傷後1年半後に毛様体解離部分を正確に同定できないまま硝子体手術，経毛様体扁平部水晶体切除術，ガスタンポナーデを施行し，術後仰臥位安静の治療を行った。初回手術後，眼圧は8mmHgと依然低値であった。前房深度が正常化し隅角検査にて下方を中心に約90°に毛様体解離が同定できたため，二期的に眼内レンズ挿入および術中隅角鏡を用いた毛様体縫着術を施行した。手術3か月後，視力は1.0へと向上し，隅角は一部周辺虹彩前癒着を認めるものの，毛様体解離は改善し，眼圧は15mmHg，脈絡膜皺襞の改善が認められた。

結論：鈍的外傷が原因で発症した水晶体偏位を伴い著明な浅前房を合併した外傷性毛様体解離で，解離範囲の同定ができない場合は，治療に難渋する可能性がある。

Abstract　Purpose：We report an intractable case of traumatic cyclodialysis with a remarkably shallow anterior chamber, which was not able to identify the range of dissection.

Case：A 33-year-old man experienced blunt trauma to the right eye during a rugby game and was referred to our hospital 1 week after the injury. His corrected visual acuity was 0.8, and his intraocular pressure（IOP）was 8 mmHg in the right eye. Cyclodialysis was suspected because of the shallow anterior depth following the forward movement of the lens.

Result：One and half years after the injury, we could not accurately identify the range of the dissection, because we could not perform vitrectomy with ultrasound biomicroscopy（UBM）or anterior optical coherence tomography（OCT）. Therefore, we performed pars plana lensectomy accompanied by intraocular gas tamponade, which was followed by the patient remaining in the supine position. After the initial surgery, the IOP remained at 8 mmHg, and gonioscopy revealed the remainder of the cyclodialysis in the 90 degrees of circumference in the sector. Secondary intraocular lens insertion and suturing of the ciliary body using intraocular gonioscopy were performed during the second operation. Three months after the surgery, visual acuity improved to 1.0, and IOP increased to 15 mmHg following improvement of the ocular findings.

Conclusion：Cyclodialysis with a remarkably shallow anterior chamber after a blunt injury can be difficult to treat without identifying the range of the dissection when the inspection is not performed with UBM or anterior OCT.