硝子体出血と続発緑内障を発症した瘢痕期未熟児網膜症の成人例

Vitreous hemorrhage and secondary glaucoma in an adult with past history of retinopathy of prematurity

35歳男性に左眼視力低下が突発し，即日受診した。生下時体重が1,280gであり，酸素の投与を受けていた。運転免許をもっていたが，右眼は弱視であったという。矯正視力は右眼0.01，左眼手動弁で，眼圧は右眼15mmHg，左眼53mmHgであった。右眼に牽引乳頭があり，瘢痕期未熟児網膜症と推定した。左眼には角膜浮腫，前房出血，硝子体出血があった。保存的治療で眼圧は正常化し，硝子体出血は消失した。発症から10日後の左眼矯正視力は0.7で，－8Dの近視があった。11か月後に左眼視力は1.0となり，無治療で以後の眼圧は安定している。左眼には牽引乳頭と出血源と推定される周辺部異常血管からの蛍光漏出と無灌流域があった。緑内障の原因として，赤血球による隅角閉塞と大量出血による硝子体腔の容積増加が推定された。成人の硝子体出血に過去の未熟児網膜症が関与した1例である。

A 35-year-old male developed acute visual disturbance in his left eye. He had weighed 1,280g at birth. He had received oxygen for retinopathy of prematurity（ROP）. His right eye had been amblyopic since childhood. When seen the same day ,the visual acuity was 0.01 right and hand motion left. The intraocular pressure（IOP）was 15 mmHg right and 53 mmHg left. His right eye had dragged disc suggestive of cicatricial ROP. His left eye showed corneal edema,hyphema,and vitreous hemorrhage. Conservative treatment was followed by normalization of IOP and absorption of vitreous hemorrhage. Ten days after onset,his left visual acuity improved to 0.7 when corrected by－8 diopters. His left eye showed dragged disc,avascular area and abnormal vessels in the periphery,from which vitreous hemorrhage appeared to have originated. Glaucoma may have been the result of blocked chamber angle by erythrocytes and increased volume of the vitreous due to massive hemorrhage. This case illustrates that cicatricial ROP may induce vitreous hemorrhage in adulthood.