ルビーレーザー誤照射による眼障害

A case of ocular injury caused by ruby laser

　35歳の医療器械の技術者が皮膚科用のQスイッチ・ルビーレーザーを保護眼鏡なしで点検中，右眼でレーザー光を直視した。波長694nm，照射野径6mm，照射時間25nsec，照射出力10J／cm²の1回照射と推定された。翌日の受診時の右眼矯正視力は0.07であり，眼圧36mmHgで，角膜浮腫，前房の炎症細胞，虹彩腫脹，水晶体の上皮混濁，硝子体出血，中心窩の上方に浮腫を伴う網膜前出血があった。1週後に眼圧は正常化し，網膜の浮腫と出血，硝子体出血が軽減した。2週後に凝固部に網膜円孔と網膜上膜が生じた。6か月後の右眼視力は0.8であった。プレドニゾロンの全身投与が，網脈絡膜の瘢痕化，黄斑皺襞進展と網膜下新生血管発生の抑制に有効であると判断された。

A 35-year-old medical engineer accidentally exposed his right eye to Q-switched ruby laser. He was not wearing protective goggles. The causative laser was designed for skin lesions and was 694nm in wavelength, 6 mm in width, 25 nsec as exposure time and 10J/cm² in power output. When seen by us the next day, the corrected visual acuity was 0.07 with the intraocular pressure of 36 mmHg. The right eye showed corneal edema, inflam-matory cells in the aqueous, iris swelling and opaque lens capsule. Funduscopy showed vitreous hemorrhage and preretinal hemorrhage surrounded by edema superior to the macula. The intraocular pressure normalized one week later associated with resolution of vitreous and retinal hemorrhage. Retinal hole and epiretinal membrane developed two weeks after injury. The visual acuity improved to 0.8 six months later. Systemic prednisolone appeared to be beneficial in inhibiting chorioretinal scarring, preretinal membrane formation and subretinal neovascularization.