重症眼球穿孔損傷に対する二段階アプローチと低侵襲硝子体手術：症例報告

BACKGROUND This report describes a case in which a 2-stage approach and minimally invasive vitrectomy successfully treated a giant retrobulbar hematoma caused by an ocular perforation injury. CASE REPORT A 22-year-old man sustained an ocular perforation injury from an iron wire. Emergency debridement and suturing of an anterior scleral laceration were performed. B-scan ultrasonography revealed a giant retrobulbar hematoma and posterior scleral laceration after the initial suturing procedure. Ten days later, minimally invasive vitrectomy was performed. During this procedure, intraocular hemorrhage was removed and vitreous traction was released. Laser photocoagulation was applied only to the edges of the posterior chorioretinal wound, and the surgery was completed with air tamponade. Three months after vitrectomy, the injured eye showed satisfactory recovery. B-scan ultrasonography confirmed resolution of the retrobulbar hematoma and closure of the posterior scleral wound. CONCLUSIONS A 2-stage, minimally invasive surgical approach for severe ocular perforation injury was performed at an appropriate time, yielding favorable therapeutic outcomes. In cases of posterior perforating injury of the globe, careful selection of surgical timing is essential; simple vitrectomy combined with air tamponade is safe and effective.