大量の硝子体出血により緑内障発作を起こした加齢黄斑変性の1例

Acute glaucoma secondary to massive vitreous hemorrhage in a case of age-related macular degeneration

　76歳男性が左眼視力低下で受診した。矯正視力は右1.0，左0.05で，右眼に軟性ドルーゼン，左眼に加齢黄斑変性があった。8か月後に中等度の硝子体出血が左眼に発症した。硝子体手術を予定したが，硝子体出血が急速に増悪し，緑内障発作が起こり，視力が0になった。硝子体出血により毛様体と水晶体が前方に偏位し，隅角を閉塞して緑内障になったと推定した。緊急に白内障手術と硝子体手術を行い，眼圧は正常化したが視力は0のままであった。本症例には抗凝固療法は行わず，止血機能には異常がなかった。既往歴として高血圧があり，これと関連した脈絡膜血管の脆弱性が大量の硝子体出血を惹起した可能性がある。

　A 76-year-old male presented with blurring in his left eye. His corrected visual acuity was 1.0 right and 0.05 left. He was diagnosed with soft drusen in the right eye and age-related macular degeneration in the left. Moderate vitreous hemorrhage developed in the left eye 8 months later. While he was waiting for vitreous surgery,vitreous hemorrhage showed acute exacerbation with acute angle-closure glaucoma. The visual acuity became no light perception. The glaucoma was secondary to anterior displacement of ciliary body and the lens due to massive vitreous hemorrhage. Simultaneous cataract and vitreous surgery induced control of intraocular pressure. The visual acuity did not improve. The patient did not receive anticoagulant therapy and had normal hemostatic function. Systemic hypertension was the sole associated feature. Weakness of choroidal vessels appeared to have led to massive vitreous hemorrhage.