瘢痕期未熟児網膜症の両眼に続発した急性閉塞隅角症の1例

A case of acute angle closure in both eyes following cicatricial retinopathy of prematurity

要約　緒言：成人における瘢痕期未熟児網膜症の両眼に急性閉塞隅角症を発症した1例を報告する。

症例：20歳，男性。在胎24週，出生体重718gで出生し，生後2〜4か月時に両眼のレーザー光凝固を施行され，12歳時以降は通院が途絶えていた。20歳時，左眼の霧視のため前医を受診し，左眼の急性閉塞隅角症による高眼圧と診断され，加療目的に名古屋大学医学部附属病院へ紹介となった。最高矯正視力は右0.04，左0.4，眼圧は右10mmHg，左45mmHgであった。両眼ともに浅前房で，左眼には角膜浮腫と結膜充血がみられた。左眼の瞳孔は2mm程度に縮瞳しており，前医における2％ピロカルピン点眼の影響が考えられた。受診翌日，左眼の水晶体再建術を型通り施行した。術翌日，左眼圧は9mmHgまで下降したが，右眼の霧視が生じ，眼圧61mmHgと高眼圧がみられた。右眼の急性閉塞隅角症として，同日，右眼の水晶体再建術を施行した。術後，両眼とも前房深度は改善し，良好な眼圧コントロールが得られた。

結論：瘢痕期未熟児網膜症患者では急性閉塞隅角症を発症する可能性があり，発症眼のみならず，僚眼に対する治療も速やかに検討されるべきである。

Abstract　Introduction：We report a case of acute angle closure in both eyes of an adult with cicatricial retinopathy of prematurity.

Case：A 20-year-old male patient born at 24 weeks of gestation and weighing 718 g at birth underwent bilateral laser photocoagulation between 2 and 4 months of age. Ophthalmology follow-up was discontinued at age 12. At age 20, he developed blurred vision in the left eye, was diagnosed with acute angle closure with high intraocular pressure（IOP） in the left eye, and was referred to our hospital for treatment. Best corrected visual acuity and IOP were 0.04（decimal notation） and 10 mmHg, respectively, in the right eye, and 0.4 and 45 mmHg, respectively, in the left eye. Both eyes showed shallow anterior chambers. The left eye had corneal edema and conjunctival hyperemia, with the pupil constricted to approximately 2 mm. Cataract surgery was performed on the left eye. On the day after surgery, IOP of the left eye had decreased to 9 mmHg, but blurred vision developed in the right eye, with elevated IOP（61 mmHg）. Acute angle closure was diagnosed in the right eye, and cataract surgery was subsequently performed. After surgery, anterior chamber depth improved and IOP reached normal levels in both eyes.

Conclusion：Patients with cicatricial retinopathy of prematurity may develop acute angle closure, and prompt consideration of treatment is warranted not only for the affected eye but for the fellow eye as well.