硝子体切除術後眼に対する眼内レンズ二次挿入時に生じた駆逐性出血

Suprachoroidal hemorrhage during secondary intraocular lens implantation in an eye with prior vitrectomy

　51歳男性の左眼の眼内異物に対して硝子体手術と水晶体切除術が6か月前に行われた。今回，眼内レンズ二次挿入のために毛様体扁平部に灌流用ポートを作り，灌流下で強角膜トンネルを作製した際に虹彩脱出が生じた。灌流を中止し，眼内レンズを嚢外に固定した。その直後に出血性脈絡膜剥離と網膜剥離が生じた。経強膜ドレナージを行い，硝子体をSF₅で置換して手術を終わった。その後，前房と硝子体出血で眼底が透見不能となった。手術の16日後に硝子体腔を洗浄したところ，脈絡膜剥離は消失していた．最終視力は0.9であった。硝子体切除の既往のある眼に灌流を行わずに眼内レンズを挿入したために眼圧が急激に低下し，駆逐性上脈絡膜出血が生じたと推定した。

A 51-year-old man had received vitrectomy and lensectomy for intraocular foreign body in his left eye 6 months before. Preliminary to secondary intraocular lens (IOL) implantation, a pars plana infusion port was created. The iris prolapsed during perfusion through an sclerocorneal tunnel. An IOL was inserted and sulcus-fixated without perfusion. Hemorrhagic choroidal detachment and retinal detachment developed immediately. We performed transscleral drainage and replaced the vitreous by sulfur hexafluoride. Hyphema and vitreous hemorrhage occurred later. Choroidal detachment had disappeared when the vitreous was irri-gated 16 days later. The affected eye regained the final visual acuity of 0.9. It appeared that the expulsive cho-roidal hemorrhage was caused by rapid ocular hypotony during IOL insertion without irrigation. Prior vitrec-tomy appeared to be another contributing factor.