白内障との同時手術が奏効したアトピー性網膜剥離の1例

Successful treatment in a case of atopic cataract and retinal detachment

　両眼にアトピー性白内障と網膜剥離とを合併する18歳男性の1例を経験した。初診時は両眼とも成熟白内障のため眼底は透見不能であった。超音波検査では右眼の網膜剥離を予想できたが，左眼に異常はなかった。Lensectomy直後の眼底検査で，左眼にも網膜剥離が発見された。右眼は乳頭を観察し得ないPVR-D3の状態で，鋸状縁断裂を認めた。左眼は黄斑部を含む下方半周の扁平網膜剥離であり周辺網膜に小裂孔を認めた。さらに，毛様体扁平部の透明な膜様物が周辺網膜を牽引する所見と，毛様体突起部の萎縮所見が両眼に観察された。両眼とも白内障手術直後に硝子体手術とレーザー光凝固を実施した。以後1年半網膜剥離の再発はなく，視力良好である。

　アトピー性白内障では網膜剥離の合併を念頭におき，白内障術直後の眼底検査を行うべきである。本症例では網膜剥離の早期発見と適切な術式の選択が，良好な予後を得た理由と思われた。透明な膜様物はアトピー性網膜剥離の発症に重要な役割を演じていると思われた。

A 18-year-old male presented with mature cata-ract in both eyes. He had been suffering from atopic dermatitis and asthma from infancy on. Retinal detachment was detected by ultrasonography in the right eye and during lensectomy in the left eye. Proliferative vitreoretinopathy D3 with small oral dialysis was present in the right eye and flat detach-ment involving the inferior fundus hemisphere with 2 small holes in the periphery in the left. We treated the retinal detachment in both eyes immediatelyafter lensectomy.

The surgical outcome was favorable in both eyes. We advocate careful evaluation of the fundus immediately after surgery for atopic cataract in order to facilitate early detection of retinal detach-ment complicating the cataract. A translucent membrane was seen extending from the pars plana to ora serrata along the whole circumference in the present case. This membrane seemed to be related with the pathogenesis of atopic retinal detachment.