白内障術後に閉塞隅角緑内障を発症し手術を要したアトピー性皮膚炎の2例

Atopic dermatitis with angle-closure glaucoma after cataract surgery

要約　目的：閉塞隅角緑内障による高眼圧に対して緑内障手術を要したアトピー性皮膚炎の2例を報告する。

症例：（症例1）40歳，男性。X−16年に右白内障手術を受けた。X年に右高眼圧の加療目的で横浜南共済病院（当院）を紹介され受診した。眼圧は右30mmHg，左10mmHg，隅角は周辺虹彩前癒着が多発していた。また前房内には硝子体脱出を認めた。右隅角癒着解離術＋線維柱帯切開術（眼内法）＋前部硝子体切除術を施行し，眼圧は12±4.0mmHgで推移していた。しかし，術後1年で右33mmHg，左13mmHgと上昇を認めた。隅角は再度周辺虹彩前癒着が多発しており右線維柱帯切除術を施行した。術後眼圧は4mmHg程度で推移した。

（症例2）46歳，男性。Y−3年に右急性緑内障発作に対して周辺虹彩切除術を受けた。のちに右白内障手術＋前部硝子体切除術を施行した。術後2か月で通院を自己中断した。Y年，右高眼圧の加療目的で当院を紹介され受診した。眼圧は右30mmHg，左14mmHg，前房に硝子体脱出を認め，隅角の2/3以上に周辺虹彩前癒着を認めた。右線維柱帯切開術（眼内法）＋前部硝子体切除術を予定していたが，術当日に眼内レンズ偏位を認め，右チューブシャント手術（アーメド緑内障バルブ）＋眼内レンズ抜去，強膜内固定＋硝子体切除術に術式を変更した。術後は眼圧12mmHg程度で推移した。

結論：閉塞隅角緑内障で緑内障手術を要したアトピー性皮膚炎の2例を経験した。

Abstract　Introduction：We report two cases of atopic dermatitis that required glaucoma surgery for high intraocular pressure due to angle-closure glaucoma.

Cases：（Case 1） A 40-year-old man. He underwent right cataract surgery in X−16. In X, he was referred to the hospital for treatment of right high intraocular pressure. His intraocular pressure was 30/10 mmHg, and there were multiple peripheral anterior synechiae in the angle. Vitreous prolapse was also observed in the anterior chamber. Right trabeculotomy（intraocular method）＋anterior vitrectomy was performed, and the intraocular pressure remained at 12±4.0 mmHg. However, one year after surgery, it increased to 33/13 mmHg. Multiple peripheral anterior synechiae were again observed in the angle, so right trabeculectomy was performed. Postoperative intraocular pressure remained at about 4 mmHg.

（Case 2） A 46-year-old man, Y−3, underwent peripheral iridectomy for an acute right glaucoma attack. Later, right cataract surgery＋anterior vitrectomy was performed. The patient discontinued visiting the hospital 2 months after surgery. In year Y, the patient was referred to the hospital for treatment of right ocular hypertension. Intraocular pressure was 30/14 mmHg, vitreous prolapse was found in the anterior chamber, and peripheral anterior iris synechiae was found in more than 2/3 of the angle. Right trabeculotomy（intraocular method）＋anterior vitrectomy was planned, but on the day of surgery, intraocular lens displacement was found, so the surgical procedure was changed to right tube shunt surgery（Ahmed glaucoma valve）＋intraocular lens removal, intrascleral fixation＋vitrectomy. Postoperatively, intraocular pressure remained at approximately 12 mmHg.

Conclusion：We experienced two cases of atopic dermatitis that required glaucoma surgery for high intraocular pressure due to angle-closure glaucoma.