若年性関節リウマチに併発した白内障に対する手術

Surgical management of cataract in a child with juvenile rheumatoid arthritis

　若年性関節リウマチに併発した白内障に対して，水晶体切除術，前部硝子体切除術を行い良好な経過を得た8歳，女児の1例を経験した。2歳時に単関節型若年性関節リウマチと診断され，その9か月後に右眼に虹彩炎が生じ，ステロイド薬の内服と点眼を行ったが虹彩炎は持続した。8歳時に膨隆虹彩になり，レーザー虹彩切開術でいったん寛解したが，その4週後に眼圧が再上昇して当科を受診した。視力は右手動弁，左1.0であり，右眼に虹彩後癒着と成熟白内障があった。左眼は正常であった。全身麻酔下で右眼に白内障手術を行った。強角膜切開創経由で虹彩後癒着を剥離し，水晶体を吸引したのち，毛様体扁平部経由で水晶体嚢と前部硝子体をできるだけ完全に切除した。術後経過は良好で，眼圧は正常化し，0.2の矯正視力が12日後に得られた。若年性関節リウマチに伴う白内障の手術においては，cyclitic membraneの形成や続発する予後不良の低眼圧を防ぐため，完全な水晶体切除および硝子体基底部の前部硝子体を十分に切除することが重要であると考えられた。

A case of 8-year-old child with juvenile rheumatoid arthritis (JRA) -assocciated cataract was suc-cessfully treated with cataract surgery. She was diagnosed as monoarticular JRA at the age of 2 years. Iritis developed in the right eye 9 months later. It persisted in spite of treatment with systemic and topical corticosteroid. Iris gibbera developed at the age of 8 years. Laser iridotomy was only temporarily effective. She was referred to us for elevated intraocular pressure 4 weeks later. Her visual acuity was hand motion right and 20/20 left. The right eye showed posterior synechia and mature cataract. The left eye was normal. Cataract surgery was performed by lens aspiration after releasing the posterior synechia. Pars plana vitrectomy was performed to remove the lens capsule and anterior vitreous. The postoperative course was uneventful. The intraocular pressure had normalized with the visual acuity of 20/100 12 days later. It is suggested that complete lensectomy and meticulous anterior vitrectomy especially at the vitreous-base is essential to the treatment of JRA-associated cataract to prevent the formation of cyclitic membrane and sebsequent intractable hypotony.