眼外傷に対する硝子体手術後に交感性眼炎をきたした2例

Two cases of sympathetic ophthalmia after vitrectomy for ocular trauma

要約　目的：眼外傷に対する硝子体手術後に交感性眼炎をきたし，早期のステロイド治療で良好な視力を得た2例を経験した。

症例1：36歳，女性。右眼を打撲して眼球破裂をきたし，同日，強膜縫合術，水晶体超音波乳化吸引術と硝子体手術を施行したところ経過良好であった。受傷後62日目に両眼の肉芽腫性汎ぶどう膜炎を認めたためメチルプレドニゾロン 1,000mg/日を3日間投与後，プレドニゾロン 40mg/日の内服に切り替えて漸減した。治療後13か月目にプレドニゾロンを中止したが眼炎症を認めず，治療後15か月目で両眼とも視力（1.5）であった。HLA-DR4は陽性であった。

症例2：64歳，男性。右眼を打撲し前房出血，隅角離断，水晶体亜脱臼を認めた。前房出血は自然消退し，受傷後2か月目に虹彩整復術，水晶体超音波乳化吸引術，硝子体手術，眼内レンズ強膜内固定術を施行した。術後経過は良好であったが術後50日目に両眼に肉芽腫性汎ぶどう膜炎を認めた。HLA-DR4は陰性であった。メチルプレドニゾロン 1,000mg/日を3日間投与後，プレドニゾロン 30mg/日の内服に切り替えたが，漸減中に眼炎症の増悪と寛解を繰り返した。以後漸減し，ステロイド治療後8か月目のプレドニゾロン 10mg/日内服下で眼炎症の増悪を認めず，視力は右（1.2），左（1.5）であった。

結論：眼外傷に対する硝子体手術後に交感性眼炎をきたしたが，早期のステロイド治療により経過良好であった。

Abstract　Purpose：To report two cases of sympathetic ophthalmia following vitrectomy for ocular trauma, in which good vision was achieved with prompt steroid treatment.

Case 1：36-year-old woman. The right eye was bruised, resulting in rupture of the globe. On the same day, scleral suturing, ultrasonic phacoemulsification of the lens, and vitrectomy were performed, and the patient did well. On day 62 after the injury, granulomatous panuveitis of both eyes was observed, for which the patient was treated with methylprednisolone 1000 mg intravenously for 3 days, then switched to prednisolone 40 mg orally that was tapered off. The prednisolone was discontinued at 13 months post-treatment, but no relapse. At 15 months post-treatment, both eyes were doing well with a best-corrected visual acuity（BCVA）of 1.5. HLA-DR4 was positive.

Case 2：64-year-old man. The right eye was bruised with anterior chamber hemorrhage, goniodialysis, and lens subluxation. The anterior chamber hemorrhage resolved spontaneously. At 2 months after the injury, the patient underwent iris reconstruction, phacoemulsification and aspiration of the lens, intraocular lens intrascleral fixation and vitrectomy. The patient's postoperative course was good, but on postoperative day 50, he patient presented with granulomatous panuveitis of both eyes. HLA-DR4 was negative. After a 3-day infusion of 1,000 mg of methylprednisolone, the patient was started on prednisolone 30 mg, with repeated exacerbations and remissions observed during titration. Thereafter, the dose was tapered off, and at 8 months after the start of steroid treatment, the patient had no relapse occurred under prednisolone 10 mg and both eyes were doing well with BCVA of 1.2 in the right eye and 1.5 in the left eye.

Conclusion：Here we described two cases of sympathetic ophthalmia following vitrectomy for ocular trauma, that had a good course with early steroid treatment. When sympathetic ophthalmia is diagnosed, early treatment initiation may lead to good vision.