外傷性毛様体上皮剥離に巨大裂孔網膜剥離を合併した1例

A case of giant rhegmatogenous retinal detachment with traumatic detachment of ciliary epithelium

　35歳女性が交通事故で顔面を強打し，両眼の飛蚊症で受傷10週後に受診した。以前に家庭内暴力による数回の顔面外傷の既往があった。初診時の矯正視力は両眼とも1.2であった。両眼に虹彩炎と硝子体内の色素塊，全周に及ぶ毛様体上皮剥離があった。その9日後に左眼視野欠損が突発した。視力は手動弁で，眼底上方に巨大裂孔と翻転網膜を伴う網膜剥離があった。パーフルオデカリンとC₃F₈を併用する硝子体手術で網膜は復位した。右眼には予防的に網膜光凝固を行い，以後16か月間安定している。外傷性の広範な毛様体上皮剥離には，光凝固または輪状締結術などの網膜剥離に対する予防処置が望ましいことを示す症例である。

A 35-year-old woman was hit in her face during a traffic accident. She was referred to us 10 weeks later for seeing floaters in both eyes. She had a history of repeated trauma to her face by domestic violence. When seen by us, her corrected visual acuity was 1.2 in either eye. Both eyes showed signs of iritis, pigment clumps in the vitreous, and detach-ment of ciliary epithelium over the whole circumference. She developed acute visual field defect in her left eye 9 days later. The left visual acuity was hand motion. Retinal detachment with a giant tear was present in the superior hemisphere. Retinal reattachment was obtained by vitrectomy with adjunct use of perfluorodecalin and perfluoropropane. The right eye has been doing well after prophylactic laser photocoagulation. This case illustrates the necessity of photocoagulation or scleral buckling for traumatic extensive detachment of ciliary epithelium in order to prevent secondary retinal detach-ment.